Addition of N‐terminal pro‐B natriuretic peptide to soluble fms‐like tyrosine kinase‐1/placental growth factor ratio > 38 improves prediction of pre‐eclampsia requiring delivery within 1 week: a longitudinal cohort study
ABSTRACT Objective Short‐term prediction of pre‐eclampsia (PE) using the soluble fms‐like tyrosine kinase‐1 (sFlt‐1)/placental growth factor (PlGF) ratio is characterized by frequent false‐positive results. As such, no treatment can be recommended to test‐positive patients and multiple measurements...
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| Veröffentlicht in: | Ultrasound in obstetrics & gynecology 2018-06, Vol.51 (6), p.758-767 |
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| creator | Sabriá, E. Lequerica‐Fernández, P. Lafuente-Ganuza, P. Eguia-Ángeles, E. Escudero, A. I. Martínez‐Morillo, E. Barceló, C. Álvarez, F. V. |
| description | ABSTRACT
Objective
Short‐term prediction of pre‐eclampsia (PE) using the soluble fms‐like tyrosine kinase‐1 (sFlt‐1)/placental growth factor (PlGF) ratio is characterized by frequent false‐positive results. As such, no treatment can be recommended to test‐positive patients and multiple measurements are often required. The aim of this study was to evaluate the effectiveness of N‐terminal pro‐B natriuretic peptide (NT‐proBNP), uric acid and the sFlt‐1/PlGF ratio for prediction of delivery with PE within 1 week in singleton pregnancies with suspected PE and sFlt‐1/PlGF ratio > 38.
Methods
This was a longitudinal prospective cohort study of singleton pregnancies presenting at 24 + 0 to 36 + 6 weeks of gestation with clinically suspected PE and sFlt‐1/PlGF ratio > 38, enrolled between January 2015 and June 2017. Multiple samples per patient were allowed but were restricted to one sample per gestational week. From 495 enrolled patients, 270 blood samples from 134 patients were ultimately analyzed. By using generalized estimating equations (GEE), the best‐fit model was selected for prediction of delivery with PE within 1 week. The predictive value of this model was then assessed using area under the paired‐ROC curve (AUC) analysis.
Results
The best‐fit model included the sFlt‐1/PlGF ratio, NT‐proBNP and the gestational week at the time of the measurement. This combined model was compared with the GEE model based on the sFlt‐1/PlGF ratio and the gestational week at the time of the measurement (reduced model). The AUC for the combined model was 0.845 (95% CI, 0.787–0.896), which was significantly greater (P = 0.011) than that of the reduced model (0.786 (95% CI, 0.722–0.844)).
Conclusion
The addition of NT‐proBNP assessment improves the short‐term prediction of delivery as a result of PE compared with sFlt‐1/PlGF ratio alone, when the sFlt‐1/PlGF ratio is > 38. This finding should be considered in future research on the assessment of short‐term risk of delivery as a result of PE. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
Linked Comment: Ultrasound Obstet Gynecol 2018; 51: 718–718 |
| doi_str_mv | 10.1002/uog.19040 |
| format | Article |
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Objective
Short‐term prediction of pre‐eclampsia (PE) using the soluble fms‐like tyrosine kinase‐1 (sFlt‐1)/placental growth factor (PlGF) ratio is characterized by frequent false‐positive results. As such, no treatment can be recommended to test‐positive patients and multiple measurements are often required. The aim of this study was to evaluate the effectiveness of N‐terminal pro‐B natriuretic peptide (NT‐proBNP), uric acid and the sFlt‐1/PlGF ratio for prediction of delivery with PE within 1 week in singleton pregnancies with suspected PE and sFlt‐1/PlGF ratio > 38.
Methods
This was a longitudinal prospective cohort study of singleton pregnancies presenting at 24 + 0 to 36 + 6 weeks of gestation with clinically suspected PE and sFlt‐1/PlGF ratio > 38, enrolled between January 2015 and June 2017. Multiple samples per patient were allowed but were restricted to one sample per gestational week. From 495 enrolled patients, 270 blood samples from 134 patients were ultimately analyzed. By using generalized estimating equations (GEE), the best‐fit model was selected for prediction of delivery with PE within 1 week. The predictive value of this model was then assessed using area under the paired‐ROC curve (AUC) analysis.
Results
The best‐fit model included the sFlt‐1/PlGF ratio, NT‐proBNP and the gestational week at the time of the measurement. This combined model was compared with the GEE model based on the sFlt‐1/PlGF ratio and the gestational week at the time of the measurement (reduced model). The AUC for the combined model was 0.845 (95% CI, 0.787–0.896), which was significantly greater (P = 0.011) than that of the reduced model (0.786 (95% CI, 0.722–0.844)).
Conclusion
The addition of NT‐proBNP assessment improves the short‐term prediction of delivery as a result of PE compared with sFlt‐1/PlGF ratio alone, when the sFlt‐1/PlGF ratio is > 38. This finding should be considered in future research on the assessment of short‐term risk of delivery as a result of PE. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
Linked Comment: Ultrasound Obstet Gynecol 2018; 51: 718–718</description><identifier>ISSN: 0960-7692</identifier><identifier>EISSN: 1469-0705</identifier><identifier>DOI: 10.1002/uog.19040</identifier><identifier>PMID: 29498431</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>generalized estimating equations ; longitudinal study ; NT‐proBNP ; pre‐eclampsia rule‐in ; sFlt‐1/PlGF ratio</subject><ispartof>Ultrasound in obstetrics & gynecology, 2018-06, Vol.51 (6), p.758-767</ispartof><rights>Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c2750-21760bd7752f325905e3da65cd5d1372b1e46fae47101ab46626da70857451b23</citedby><cites>FETCH-LOGICAL-c2750-21760bd7752f325905e3da65cd5d1372b1e46fae47101ab46626da70857451b23</cites><orcidid>0000-0003-3339-1362</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fuog.19040$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fuog.19040$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1416,1432,27923,27924,45573,45574,46408,46832</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29498431$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sabriá, E.</creatorcontrib><creatorcontrib>Lequerica‐Fernández, P.</creatorcontrib><creatorcontrib>Lafuente-Ganuza, P.</creatorcontrib><creatorcontrib>Eguia-Ángeles, E.</creatorcontrib><creatorcontrib>Escudero, A. I.</creatorcontrib><creatorcontrib>Martínez‐Morillo, E.</creatorcontrib><creatorcontrib>Barceló, C.</creatorcontrib><creatorcontrib>Álvarez, F. V.</creatorcontrib><title>Addition of N‐terminal pro‐B natriuretic peptide to soluble fms‐like tyrosine kinase‐1/placental growth factor ratio > 38 improves prediction of pre‐eclampsia requiring delivery within 1 week: a longitudinal cohort study</title><title>Ultrasound in obstetrics & gynecology</title><addtitle>Ultrasound Obstet Gynecol</addtitle><description>ABSTRACT
Objective
Short‐term prediction of pre‐eclampsia (PE) using the soluble fms‐like tyrosine kinase‐1 (sFlt‐1)/placental growth factor (PlGF) ratio is characterized by frequent false‐positive results. As such, no treatment can be recommended to test‐positive patients and multiple measurements are often required. The aim of this study was to evaluate the effectiveness of N‐terminal pro‐B natriuretic peptide (NT‐proBNP), uric acid and the sFlt‐1/PlGF ratio for prediction of delivery with PE within 1 week in singleton pregnancies with suspected PE and sFlt‐1/PlGF ratio > 38.
Methods
This was a longitudinal prospective cohort study of singleton pregnancies presenting at 24 + 0 to 36 + 6 weeks of gestation with clinically suspected PE and sFlt‐1/PlGF ratio > 38, enrolled between January 2015 and June 2017. Multiple samples per patient were allowed but were restricted to one sample per gestational week. From 495 enrolled patients, 270 blood samples from 134 patients were ultimately analyzed. By using generalized estimating equations (GEE), the best‐fit model was selected for prediction of delivery with PE within 1 week. The predictive value of this model was then assessed using area under the paired‐ROC curve (AUC) analysis.
Results
The best‐fit model included the sFlt‐1/PlGF ratio, NT‐proBNP and the gestational week at the time of the measurement. This combined model was compared with the GEE model based on the sFlt‐1/PlGF ratio and the gestational week at the time of the measurement (reduced model). The AUC for the combined model was 0.845 (95% CI, 0.787–0.896), which was significantly greater (P = 0.011) than that of the reduced model (0.786 (95% CI, 0.722–0.844)).
Conclusion
The addition of NT‐proBNP assessment improves the short‐term prediction of delivery as a result of PE compared with sFlt‐1/PlGF ratio alone, when the sFlt‐1/PlGF ratio is > 38. This finding should be considered in future research on the assessment of short‐term risk of delivery as a result of PE. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
Linked Comment: Ultrasound Obstet Gynecol 2018; 51: 718–718</description><subject>generalized estimating equations</subject><subject>longitudinal study</subject><subject>NT‐proBNP</subject><subject>pre‐eclampsia rule‐in</subject><subject>sFlt‐1/PlGF ratio</subject><issn>0960-7692</issn><issn>1469-0705</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp1kbFuFDEQhi0EIkeg4AWQSyguN_bu2rcUSCGCgBSRhtQrrz17Z8673tjenLZLS8czpuQpMLmEjsqa0advPPMT8prBCQPgq8lvTlgNJTwhC1aKegkSqqdkAbWApRQ1PyIvYvwBAKIsxHNyxOuyXpcFW5Dfp8bYZP1AfUe_3d3-Shh6OyhHx-Bz-ZEOKgU7BUxW0xHHZA3S5Gn0bmod0q6PGXN2l7tz8NEOSHdZEDG32Wp0SuOQsm8T_D5taad08oEGlYfSD3e3P4s1tX0edoMxz0Rj9eN3cpUdqJ3qx2gVDXg92WCHDTXo7A2Gme5t2tqBsuzZI-7eU0WdHzY2TeZ-Ce23PiQacz2_JM865SK-eniPydXnT9_PviwvLs-_np1eLDWXFSw5kwJaI2XFu4JXNVRYGCUqbSrDCslbhqXoFJaSAVNtKQQXRklYV7KsWMuLY_L24M1LXU8YU9PbqNE5NaCfYsOBQSELATKj7w6ozpeLAbtmDLZXYW4YNH-jbXK0zX20mX3zoJ3aHs0_8jHLDKwOwN46nP9vaq4uzw_KP4O-uXY</recordid><startdate>201806</startdate><enddate>201806</enddate><creator>Sabriá, E.</creator><creator>Lequerica‐Fernández, P.</creator><creator>Lafuente-Ganuza, P.</creator><creator>Eguia-Ángeles, E.</creator><creator>Escudero, A. I.</creator><creator>Martínez‐Morillo, E.</creator><creator>Barceló, C.</creator><creator>Álvarez, F. V.</creator><general>John Wiley & Sons, Ltd</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-3339-1362</orcidid></search><sort><creationdate>201806</creationdate><title>Addition of N‐terminal pro‐B natriuretic peptide to soluble fms‐like tyrosine kinase‐1/placental growth factor ratio > 38 improves prediction of pre‐eclampsia requiring delivery within 1 week: a longitudinal cohort study</title><author>Sabriá, E. ; Lequerica‐Fernández, P. ; Lafuente-Ganuza, P. ; Eguia-Ángeles, E. ; Escudero, A. I. ; Martínez‐Morillo, E. ; Barceló, C. ; Álvarez, F. V.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2750-21760bd7752f325905e3da65cd5d1372b1e46fae47101ab46626da70857451b23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>generalized estimating equations</topic><topic>longitudinal study</topic><topic>NT‐proBNP</topic><topic>pre‐eclampsia rule‐in</topic><topic>sFlt‐1/PlGF ratio</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sabriá, E.</creatorcontrib><creatorcontrib>Lequerica‐Fernández, P.</creatorcontrib><creatorcontrib>Lafuente-Ganuza, P.</creatorcontrib><creatorcontrib>Eguia-Ángeles, E.</creatorcontrib><creatorcontrib>Escudero, A. I.</creatorcontrib><creatorcontrib>Martínez‐Morillo, E.</creatorcontrib><creatorcontrib>Barceló, C.</creatorcontrib><creatorcontrib>Álvarez, F. V.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Ultrasound in obstetrics & gynecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sabriá, E.</au><au>Lequerica‐Fernández, P.</au><au>Lafuente-Ganuza, P.</au><au>Eguia-Ángeles, E.</au><au>Escudero, A. I.</au><au>Martínez‐Morillo, E.</au><au>Barceló, C.</au><au>Álvarez, F. V.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Addition of N‐terminal pro‐B natriuretic peptide to soluble fms‐like tyrosine kinase‐1/placental growth factor ratio > 38 improves prediction of pre‐eclampsia requiring delivery within 1 week: a longitudinal cohort study</atitle><jtitle>Ultrasound in obstetrics & gynecology</jtitle><addtitle>Ultrasound Obstet Gynecol</addtitle><date>2018-06</date><risdate>2018</risdate><volume>51</volume><issue>6</issue><spage>758</spage><epage>767</epage><pages>758-767</pages><issn>0960-7692</issn><eissn>1469-0705</eissn><abstract>ABSTRACT
Objective
Short‐term prediction of pre‐eclampsia (PE) using the soluble fms‐like tyrosine kinase‐1 (sFlt‐1)/placental growth factor (PlGF) ratio is characterized by frequent false‐positive results. As such, no treatment can be recommended to test‐positive patients and multiple measurements are often required. The aim of this study was to evaluate the effectiveness of N‐terminal pro‐B natriuretic peptide (NT‐proBNP), uric acid and the sFlt‐1/PlGF ratio for prediction of delivery with PE within 1 week in singleton pregnancies with suspected PE and sFlt‐1/PlGF ratio > 38.
Methods
This was a longitudinal prospective cohort study of singleton pregnancies presenting at 24 + 0 to 36 + 6 weeks of gestation with clinically suspected PE and sFlt‐1/PlGF ratio > 38, enrolled between January 2015 and June 2017. Multiple samples per patient were allowed but were restricted to one sample per gestational week. From 495 enrolled patients, 270 blood samples from 134 patients were ultimately analyzed. By using generalized estimating equations (GEE), the best‐fit model was selected for prediction of delivery with PE within 1 week. The predictive value of this model was then assessed using area under the paired‐ROC curve (AUC) analysis.
Results
The best‐fit model included the sFlt‐1/PlGF ratio, NT‐proBNP and the gestational week at the time of the measurement. This combined model was compared with the GEE model based on the sFlt‐1/PlGF ratio and the gestational week at the time of the measurement (reduced model). The AUC for the combined model was 0.845 (95% CI, 0.787–0.896), which was significantly greater (P = 0.011) than that of the reduced model (0.786 (95% CI, 0.722–0.844)).
Conclusion
The addition of NT‐proBNP assessment improves the short‐term prediction of delivery as a result of PE compared with sFlt‐1/PlGF ratio alone, when the sFlt‐1/PlGF ratio is > 38. This finding should be considered in future research on the assessment of short‐term risk of delivery as a result of PE. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
Linked Comment: Ultrasound Obstet Gynecol 2018; 51: 718–718</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>29498431</pmid><doi>10.1002/uog.19040</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0003-3339-1362</orcidid><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 0960-7692 |
| ispartof | Ultrasound in obstetrics & gynecology, 2018-06, Vol.51 (6), p.758-767 |
| issn | 0960-7692 1469-0705 |
| language | eng |
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| source | Wiley Free Content; EZB-FREE-00999 freely available EZB journals; Wiley Online Library All Journals |
| subjects | generalized estimating equations longitudinal study NT‐proBNP pre‐eclampsia rule‐in sFlt‐1/PlGF ratio |
| title | Addition of N‐terminal pro‐B natriuretic peptide to soluble fms‐like tyrosine kinase‐1/placental growth factor ratio > 38 improves prediction of pre‐eclampsia requiring delivery within 1 week: a longitudinal cohort study |
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