sFlt-1–to–PlGF ratios are used in Europe due to high negative predictive value (good at ruling out preeclampsia [PE])
A cut-off value of ≥85 ratio has been associated with adverse preeclampsia (PE) outcomes
Cerdeira et al. (AJOG, 2021) evaluated the performance of the sFlt-1–to–PlGF ratio ≥85 threshold for predicting PE among high-risk patients
Posthoc analysis of the INSPIRE RCT
Primary outcome of INSPIRE:
Admission within 24 hours of test
Secondary outcomes of INSPIRE
Maternal and fetal adverse outcomes
Women with suspected PE presenting between 24w0d and 36w7d
Clinicians aware of sFlt-1–to–PlGF ratio result
Clinicians not aware of sFlt-1–to–PlGF ratio result
Outcomes of posthoc analysis (this study)
Predictive performance of the sFlt-1–to–PlGF ratio cutoff of ≥85 for ruling in PE within 4 weeks
PE prevalence: 23%
Performance characteristics of sFlt-1–to–PlGF ratio of ≥85
Sensitivity: 57.1 (95% CI, 39.4 to 73.7)
Specificity: 94.7 (95% CI, 89.8 to 97.7)
Positive predictive value (PPV): 71.4% (95% CI, 51.3 to 86.8)
In Europe, following the PROGNOSIS trial, sFlt-1–to–PlGF ratio cutoff of ≤38 has been adopted to rule out preeclampsia (PE) in high-risk pregnancies due to a high negative predictive value (99.3%; 95% CI, 97.99 to 99.9)
Using a sFlt-1–to–PlGF ratio of ≥85 for ruling in PE within 4 weeks was better at predicting PE than a cutoff ratio of 38
The authors state
Combining this cutoff of ≥85 with the rule out cutoff of <38 could improve the management of patients with suspected PE
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