Prediction of preeclampsia-related outcomes with the sFlt-1 (soluble Fms-like tyrosine kinase-1)/PlGF (placental growth factor)-ratio in the routine in twin pregnancies

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OBJECTIVES: This study evaluates the sFlt-1/PlGF ratio for predicting preeclampsia (PE)-related maternal or fetal adverse outcomes (AOs) and PE-related delivery within 1-2 weeks in twin pregnancies with suspected PE and fetal growth restriction (FGR). STUDY DESIGN: A retrospective real-world analysis was conducted including 121 twin pregnancies presenting with signs or symptoms of PE and FGR. The respective sFlt-1/PlGF ratio was assessed in relation to pregnancy outcomes. OUTCOME MEASURES: Receiver operating characteristic (ROC) curves were generated for the endpoints PE at delivery, PE/FGR-related delivery, delivery within 1-2 weeks, and AOs. Maternal AOs included HELLP syndrome, renal failure, pulmonary edema, disseminated intravascular coagulation, cerebral hemorrhage, eclampsia, or maternal death. Fetal AOs comprised respiratory distress syndrome, necrotizing enterocolitis, intraventricular hemorrhage, delivery ≤ 34 weeks, placental abruption, and intrauterine or neonatal death. Between-group comparisons used the Mann-Whitney-U and two-tailed Fisher's exact tests. Multivariable logistic regression identified associations between clinical symptoms and AOs. RESULTS: Forty-five patients (37.2 %) developed AOs; 37 (30.6 %) developed PE; and 42 (34.7 %) required PE/FGR-related delivery. The sFlt-1/PlGF ratio predicted AOs with an area under the curve (AUC) of 0.74 (95 % CI 0.64-0.82) and an optimal cutoff of 52.7. PE/FGR-related delivery within 1-2 weeks yielded AUCs of 0.82 (95 % CI 0.74-0.90) and 0.83 (95 % CI 0.76-0.91). Diagnosis of PE at birth showed an AUC of 0.82 (95 % CI 0.76-0.91), with an optimal cutoff of 45. CONCLUSIONS: The sFlt-1/PlGF ratio demonstrates high accuracy in predicting AOs and time to delivery in twin pregnancies. Optimal cutoff values differ from those established for singleton gestations.