Why the study?
Angiogenic biomarkers aid in short-term preeclampsia prediction but are often limited by false-positive results, and whether adding NT-proBNP to the sFlt-1/PlGF ratio improves prediction within 1 week was evaluated.
Does adding NT-proBNP to the sFlt-1/PlGF ratio improve the short-term prediction of preeclampsia in pregnancies with suspected preeclampsia?
Does adding NT-proBNP to the sFlt-1/PlGF ratio improve the short-term prediction of preeclampsia in pregnancies with suspected preeclampsia?
Adding NT-proBNP to the sFlt-1/PlGF ratio enhances the short-term prediction of preeclampsia, particularly in intermediate-risk pregnancies, potentially refining risk stratification.
Answers are grounded in this paper and cite their sources.
May refine short-term PE risk stratification in intermediate sFlt-1/PlGF cases; leaves open whether multimarker use improves outcomes in prospective trials.
BACKGROUND: Angiogenic biomarkers aid in short-term prediction of preeclampsia (PE) but are often limited by false-positive results. N-terminal pro-B-type natriuretic peptide (NT-proBNP), which is elevated in PE due to cardiovascular dysfunction, may enhance diagnostic precision. This study evaluated whether adding NT-proBNP to the soluble fms-like tyrosine kinase-1 (sFlt-1)/placental growth factor (PlGF) ratio improves prediction of PE and associated complications within 1 week. METHODS: We performed a prospective multicenter case-control study in pregnancies with suspected PE between 24 + 0 and 41 + 0 weeks. Three models evaluated the addition of NT-proBNP (cutoff ≥116 pg/mL) to the sFlt-1/PlGF ratio using thresholds <38, ≥85, and 38 to 84. All models were assessed for early-onset, preterm, term, and overall PE prediction using receiver operating curve analysis, predictive metrics, and Kaplan-Meier survival curves. RESULTS: A total of 316 women (424 serum samples) were included. PE occurred in 23.4% of cases, including 8.5% early-onset PE. NT-proBNP levels were significantly elevated in PE cases. The addition of NT-proBNP improved early-onset PE prediction, particularly in intermediate-risk cases (sFlt-1/PlGF 38-84), achieving an area under the curve (AUC) of 0.949 and a negative predictive value (NPV) of 99.5%, outperforming sFlt-1/PlGF alone. Survival analysis revealed a shorter median time to delivery when both biomarkers were elevated (1.3 vs 4.0 weeks; P < 0.001). For term PE, NT-proBNP increased positive predictive value when combined with sFlt-1/PlGF ≥ 38. In complicated PE, the combined model improved specificity (77.4%) and AUC (0.770), with an NPV of 91.1%. CONCLUSIONS: NT-proBNP enhances the short-term predictive performance of the sFlt-1/PlGF ratio, particularly in intermediate-risk cases. This multimarker approach may refine risk stratification and support timely clinical intervention in pregnancies at risk of PE.
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Garrido-Gimenez et al. (2025) studied this question.
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