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Added prognostic value of longitudinal changes of angiogenic factors in early-onset severe preeclampsia: analysis of maternal outcomes.
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  • Anna Peguero,
  • Lorena Fernandez-Blanco,
  • Edurne Mazarico,
  • Leticia Benitez,
  • Alba Gonzalez,
  • Lina Youssef,
  • Fatima Crispi,
  • Sandra Hernández,
  • Francesc Figueras
Anna Peguero
Hospital Clinic de Barcelona Institut Clinic de Ginecologia Obstetricia i Neonatologia
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Lorena Fernandez-Blanco
Hospital Clinic de Barcelona Institut Clinic de Ginecologia Obstetricia i Neonatologia
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Edurne Mazarico
Hospital Sant Joan de Deu
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Leticia Benitez
Hospital Clinic de Barcelona Institut Clinic de Ginecologia Obstetricia i Neonatologia
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Alba Gonzalez
Hospital Sant Joan de Deu
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Lina Youssef
Hospital Clinic de Barcelona Institut Clinic de Ginecologia Obstetricia i Neonatologia
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Fatima Crispi
Hospital Clinic de Barcelona Institut Clinic de Ginecologia Obstetricia i Neonatologia
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Sandra Hernández
Hospital Clinic de Barcelona Institut Clinic de Ginecologia Obstetricia i Neonatologia
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Francesc Figueras
Hospital Clinic de Barcelona
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Abstract

Background: Maternal levels of angiogenic factors are promising prognostic parameters in patients with suspected preeclampsia, but in women with confirmed preeclampsia this performance has been less explored. Objective: To assess in women with early-onset severe preeclampsia whether longitudinal changes in angiogenic factors improve the prediction of adverse outcome. Study design: A cohort was created of consecutive women admitted for early-onset severe preeclampsia with no indication for immediate delivery. Levels of placental growth factor [PlGF], soluble fms-like tyrosine kinase [sFlt-1] and sFlt-1/PlGF ratio were measured at admission and before delivery; and average daily change was calculated. The association of longitudinal changes of angiogenic factors with maternal complications and with the time interval to delivery was evaluated by logistic and Cox regression. Results: Sixty-three women were analyzed, of which 23 (36.5%) had a complication. Longitudinal changes of sFlt-1 were more pronounce in complicated pregnancies (median: 1079.5 vs. 343.7 pg/mL/day; p=0.04). On the multivariate analysis, the baseline model (clinical risk score and sFlt-1 at admission) explained a 6.6% of the uncertainty for complication (R2-Naegelkerke). The addition of sFlt-1 longitudinal changes improved this performance to 23.2% (p=0.004). The median time from admission to delivery was 3 days (95% confidence interval: 1.9-4.05) in those in the highest quartile of sFlt-1 longitudinal changes vs. 10 days (95% confidence interval: 8.1-11.9) in the remaining women (Log-rank test p<0.001). Conclusions: Longitudinal changes in sFlt-1 maternal levels from admission for confirmed early-onset severe preeclampsia add to baseline characteristics in the prediction of maternal complications.

Peer review status:ACCEPTED

21 Mar 2020Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
24 Mar 2020Submission Checks Completed
24 Mar 2020Assigned to Editor
25 Mar 2020Reviewer(s) Assigned
19 Apr 2020Review(s) Completed, Editorial Evaluation Pending
06 May 2020Editorial Decision: Revise Major
23 May 20201st Revision Received
27 May 2020Submission Checks Completed
27 May 2020Assigned to Editor
31 May 2020Reviewer(s) Assigned
02 Jun 2020Editorial Decision: Revise Minor
04 Jun 20202nd Revision Received
05 Jun 2020Submission Checks Completed
05 Jun 2020Assigned to Editor
11 Jun 2020Editorial Decision: Accept