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Accuracy of circulating placental growth factor, vascular endothelial growth factor, soluble fms‐like tyrosine kinase 1 and soluble endoglin in the prediction of pre‐eclampsia: a systematic review and meta‐analysis
Author(s) -
Kleinrouweler CE,
Wiegerinck MMJ,
RisStalpers C,
Bossuyt PMM,
van der Post JAM,
von Dadelszen P,
Mol BWJ,
Pajkrt E
Publication year - 2012
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.2012.03311.x
Subject(s) - placental growth factor , soluble fms like tyrosine kinase 1 , eclampsia , medicine , preeclampsia , meta analysis , vascular endothelial growth factor , endoglin , andrology , obstetrics , gynecology , pregnancy , vegf receptors , biology , genetics , stem cell , cd34
Please cite this paper as: Kleinrouweler C, Wiegerinck M, Ris‐Stalpers C, Bossuyt P, van der Post J, von Dadelszen P, Mol B, Pajkrt E, for the EBM CONNECT Collaboration. Accuracy of circulating placental growth factor, vascular endothelial growth factor, soluble fms‐like tyrosine kinase 1 and soluble endoglin in the prediction of pre‐eclampsia: a systematic review and meta‐analysis. BJOG 2012;119:778–787. Background Biomarkers have been proposed for identification of women at increased risk of developing pre‐eclampsia. Objectives To investigate the capacity of circulating placental growth factor (PlGF), vascular endothelial growth factor (VEGF), soluble fms‐like tyrosine kinase‐1 (sFLT1) and soluble endoglin (sENG) to predict pre‐eclampsia. Search strategy Medline and Embase through October 2010 and reference lists of reviews, without constraints. Selection criteria We included original publications on testing of PlGF, VEGF, sFLT1 and sENG in serum or plasma of pregnant women at <30 weeks of gestation and before clinical onset of pre‐eclampsia. Data collection and analysis Two reviewers independently identified eligible studies, extracted descriptive and test accuracy data and assessed methodological quality. Summary estimates of discriminatory performance were obtained. Main results We included 34 studies. Concentrations of PlGF (27 studies) and VEGF (three studies) were lower in women who developed pre‐eclampsia: standardised mean differences (SMD) −0.56 (95% CI −0.77 to −0.35) and −1.25 (95% CI −2.73 to 0.23). Concentrations of sFLT1 (19 studies) and sENG (ten studies) were higher: SMD 0.48 (95% CI 0.21–0.75) and SMD 0.54 (95% CI 0.24–0.84). The summary diagnostic odds ratios were: PlGF 9.0 (95% CI 5.6–14.5), sFLT1 6.6 (95% CI 3.1–13.7), sENG 4.2 (95% CI 2.4–7.2), which correspond to sensitivities of 32%, 26% and 18%, respectively, for a 5% false‐positive rate. Author’s conclusions PlGF, sFLT1 and sENG showed modest but significantly different concentrations before 30 weeks of gestation in women who developed pre‐eclampsia. Test accuracies of all four markers, however, are too poor for accurate prediction of pre‐eclampsia in clinical practice.