sFlt-1/PlGF Ratio Predicts Short-Term Maternal-Fetal Outcomes in Chinese Hypertensive Pregnancies: A Prospective Cohort Study.

Abstract

BACKGROUND The sFlt-1 (soluble fms-like tyrosine kinase 1) and PlGF (placental growth factor) ratio holds significant value in the early identification of preeclampsia and risk stratification. However, its application within the Chinese population remains under-researched. This study evaluates the predictive performance of the sFlt-1/PlGF ratio in hospitalized Chinese patients with hypertensive disorders of pregnancy. METHODS This prospective single-center cohort study (December 2023-June 2024) enrolled East Asian women aged ≥18 years with singleton pregnancies (23 weeks to 36 weeks and 6 days of gestation) and signs or symptoms of hypertensive disorders of pregnancy. A serum sFlt-1/PlGF level of 38 was selected as the critical value to differentiate risk levels. Maternal outcomes and fetal parameters were assessed within 2 weeks post-enrollment and statistically analyzed. RESULTS The study included 132 hospitalized patients with hypertensive disorders of pregnancy, among whom 44 (33.3%) had an sFlt-1/PlGF ratio ≥38. The interval to delivery detected in the high-ratio group was significantly shorter (0.8 weeks compared with 4 weeks; P<0.001), and the risk of delivery within 2 weeks after detection was significantly increased (adjusted hazard ratio, 5.36 [95% CI, 3.42-8.39]; P<0.001). The sFlt-1/PlGF ≥38 had an area under the curve of 0.88 for predicting delivery within 2 weeks. This indicator also demonstrated good negative predictive performance in excluding maternal-fetal adverse outcomes (negative predictive values: severe preeclampsia, 0.93; severe small for gestational age, 0.93). CONCLUSIONS The sFlt-1/PlGF ratio demonstrates strong predictive value for short-term delivery in hospitalized hypertensive disorders of pregnancy patients in China. Its high negative predictive value is particularly useful in excluding the risk of maternal-fetal adverse outcomes. REGISTRATION URL: https://www.medicalresearch.org.cn; Unique identifier: MR-44-23-049132.