Markedly higher sFlt‐1/PlGF ratio in a woman with acute fatty liver of pregnancy compared with HELLP syndrome

Aim To compare serum levels of angiogenesis‐related factors between 14 women with HELLP (hemolysis, elevated liver enzymes and low platelet count) syndrome and a woman with acute fatty liver of pregnancy (AFLP). Methods Serum samples were collected in 2004–2008 and 2013–2016. The levels of soluble fms‐like tyrosine kinase 1 (sFlt‐1) and placental growth factor (PlGF) were measured by an automated electrochemiluminescence immunoassay using Elecsys sFlt‐1 and Elecsys PlGF. After logarithmic transformation, levels of sFlt‐1, PlGF and the sFlt‐1/PlGF ratio in a woman with AFLP were compared with those in women with HELLP syndrome, using the one‐sample t ‐test. Results At 37 weeks of gestation, a patient was diagnosed with AFLP based on Swansea criteria (showing six features including elevated transaminases), and she also showed a duodenal ulcer with active bleeding, thrombocytopenia and hypertension. Her serum levels of sFlt‐1 and sFlt‐1/PlGF ratio were significantly higher than in those with HELLP syndrome (273 040 pg/mL vs 15 135 [mean], P  < 0.001; 4236 vs 224, P  < 0.001; respectively). However, her serum level of PlGF was not significantly different from those with HELLP syndrome. Conclusion Serum levels of sFlt‐1 and the sFlt‐1/PlGF ratio, but not PlGF, in a woman with AFLP were markedly higher than those in women with HELLP syndrome. AFLP may be a different clinical entity from HELLP syndrome based on angiogenesis‐related factors. Clinically, the sFlt‐1/PlGF ratio may be used to rapidly distinguish AFLP from HELLP syndrome.