BACKGROUND Our objective was to investigate the predictive and diagnostic accuracy of the angiogenic proteins sFlt-1 (soluble fms-like tyrosine kinase-1) and PlGF (placental growth factor) for preterm preeclampsia and explore the relationship between renal function and these proteins. METHODS We completed a blinded, prospective, longitudinal, observational study of patients with chronic kidney disease followed at a tertiary center (2018-2023). Serum samples were obtained at 3 time points along gestation (planned sampling): 12-16, 18-22, and 28-32 weeks. In addition, samples were obtained whenever preeclampsia was suspected (indicated sampling). sFlt-1 and PlGF levels remained concealed until the study ended. The primary outcome was preterm preeclampsia. The planned and indicated samples were used to estimate the predictive and diagnostic accuracy of the angiogenic proteins, respectively. RESULTS Of the 97 participants, 21 (21.6%) experienced preterm preeclampsia. In asymptomatic patients with chronic kidney disease, the angiogenic proteins were predictive of preterm preeclampsia only when sampled in the third trimester, in which case the sFlt-1/PlGF ratio (false positive rate of 37% for a detection rate of 80%) was more predictive than either sFlt-1 or PlGF in isolation. In patients with suspected preeclampsia, the diagnostic accuracy of the sFlt-1/PlGF ratio (false positive rate of 26% for a detection rate of 80%) was higher than that of sFlt-1 and PlGF in isolation. Diminished renal function was associated with increased levels of PlGF. CONCLUSIONS sFlt-1 and PlGF can effectively predict and improve the diagnostic accuracy for preterm preeclampsia among patients with chronic kidney disease. The optimal sFlt-1/PlGF ratio cutoff to rule out preeclampsia may need to be lower in patients with impaired renal function.

中文翻译：

---

血管生成蛋白对慢性肾病患者的预测和诊断价值。


背景 我们的目的是研究血管生成蛋白 sFlt-1 （可溶性 fms 样酪氨酸激酶-1） 和 PlGF （胎盘生长因子） 对早足月子痫前期的预测和诊断准确性，并探讨肾功能与这些蛋白质之间的关系。方法 我们完成了一项针对在三级中心随访的慢性肾病患者的盲法、前瞻性、纵向、观察性研究 （2018-2023）。在妊娠 3 个时间点（计划取样）获得血清样本： 12-16 、 18-22 和 28-32 周。此外，每当怀疑子痫前期时，都会采集样本（指示采样）。sFlt-1 和 PlGF 水平一直隐藏到研究结束。主要结局是早产子痫前期。计划和指示的样本分别用于估计血管生成蛋白的预测和诊断准确性。结果 在 97 名参与者中，21 名 （21.6%） 患有早产子痫前期。在无症状的慢性肾病患者中，血管生成蛋白仅在妊娠晚期取样时可预测早产子痫前期，在这种情况下，sFlt-1/PlGF 比值 （假阳性率为 37%，检出率为 80%） 比单独使用 sFlt-1 或 PlGF 更具预测性。在疑似子痫前期患者中，sFlt-1/PlGF 比值 （假阳性率为 26%，检出率为 80%） 的诊断准确性高于单独使用 sFlt-1 和 PlGF。肾功能减退与 PlGF 水平升高相关。结论 sFlt-1 和 PlGF 可有效预测和提高慢性肾病患者早产子痫前期的诊断准确性。 对于肾功能受损的患者，排除子痫前期的最佳 sFlt-1/PlGF 比值临界值可能需要更低。