The clinical value of PlGF and the sFlt1/PlGF ratio in the management of hypertensive pregnancy disorders: a retrospective real-world study in China

The soluble fms-like tyrosine kinase 1 (sFlt1)/placental growth factor (PlGF) ratio is a useful parameter for the diagnosis of preeclampsia. However, a comprehensive comparison of the ratio in preeclampsia and other hypertensive disorders of pregnancy was still missing and the dynamic levels of PlGF in the process of these diseases needed more clinical evidence.This retrospective study included participants tested for serum sFlt1 and PlGF levels at a national hospital in China throughout 2020. Diagnostic performance of the sFlt1/PlGF ratio and blood pressure was assessed by the receiver operating characteristic (ROC) analysis. The correlation of the sFlt1/PlGF ratio with pregnancy outcomes was evaluated using Kaplan-Meier curves. Besides, the circulating levels of PlGF were monitored in the time course of different hypertensive disorders' progress.The sFlt1/PlGF ratios were significantly elevated in the women with preeclampsia. The results of ROC analysis showed that, compared with blood pressure, the ratio is reliable for preeclampsia diagnosis from healthy control and shows better performance in distinguishing preeclampsia from other hypertensive disorders of pregnancy. A higher ratio than 85 could be used as an indicator of developing severe preeclampsia with adverse outcomes such as preterm delivery. Besides, our results suggested that using PlGF to predict preeclampsia should after 20 weeks of pregnancy.The PlGF and sFlt1/PlGF ratio are worth implementing in clinical management of women with preeclampsia rather than other hypertensive disorders of pregnancy.