Dr Andrea Huang1,3,4, Dr Harsha Suresh1, A/Professor Renuka Shanmugalingam1,2, Professor Angela Makris1,2,4
1Liverpool Hospital, Sydney, Australia, 2Western Sydney University, Sydney, Australia, 3University of Sydney, Sydney, Australia, 4University of New South Wales, Sydney, Australia
Biography:
Dr Andrea Huang is a Nephrologist with a Masters in Biostatistics currently undertaking a PhD with the CODE team at University of Sydney. She has a particular interest in renal transplantation and statistics within research.
Background:
Preeclampsia (PE) commonly complicates pregnancies in women in chronic hypertension . Differentiating chronic renal disease (CKD) from preeclampsia can be difficult. The sFlt-1/PlGF (Roche) ratio is established in ruling out subsequent development of PE in women with a ratio of < 38.
Methods:
A retrospective nested cohort study of consecutive 50 singleton pregnancies in women with CKD who had sFlt-1/PlGF measured between 30th December 2020 and 31st December 2022 at Southwest Sydney Local Health District. Diagnostic performance of sFlt-1/PlGF was evaluated using R.
Results:
Overall median age was 31.5 [27,34.5] years and delivery occurred 4.8 [2.9, 7.9] weeks after sFlt-1/PlGF was assessed without a difference in between patients who did and did not develop PE. Lupus nephritis accounted for most CKD (16%) and 2 patients (4%) had renal transplants. Pre-pregnancy median creatinine was 55 [50,75]. The maximum pre-pregnancy Creatinine recorded was 220umol/L; this patient required dialysis during pregnancy. PE occurred in 70% (n=35) pregnancies . Composite maternofetal adverse outcomes were reported in 34% (n=17) of pregnancies, with no fetal deaths.
Diagnostic performance for sFlt-1/PlGF prediction of PET was performed and the area under the ROC curve was 0.66 (IQR 0.6, 0.73). Sensitivity was 33.3%, Specificity 97.1% with a negative predictive value (NPV) 77.3%. Using a cutpoint of sFlt-1/PlGF 38 gave sensitivity 20%, Specificity 97.2% and NPV 74%. Using PlGF alone with a cut off of 100pg/mL resulted in Sensitivity 13.3%, Specificity 97.1% and NPV 72.3%. Patient numbers were too small to stratify by timepoint of PE development.
Conclusions:
In this cohort of 50 patients, sFlt-1/PlGF ratio of >22 can predict PET development with high specificity but low sensitivity. Its application will need further validation.
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