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Maternal serum glycosylated fibronectin as a short-term predictor of preeclampsia: a prospective cohort study

BACKGROUND: Preeclampsia is a major pregnancy complication that results in significant maternal and infant mortality, most of which occurs in low and middle-income countries. The accurate and timely diagnosis of preeclampsia is critical in management of affected pregnancies to reduce maternal and fe...

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Autores principales: Huhn, Evelyn A., Hoffmann, Ina, Martinez De Tejada, Begoña, Lange, Soeren, Sage, Kylie M., Roberts, Charles T., Gravett, Michael G., Nagalla, Srinivasa R., Lapaire, Olav
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7041257/
https://www.ncbi.nlm.nih.gov/pubmed/32093623
http://dx.doi.org/10.1186/s12884-020-2809-2
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author Huhn, Evelyn A.
Hoffmann, Ina
Martinez De Tejada, Begoña
Lange, Soeren
Sage, Kylie M.
Roberts, Charles T.
Gravett, Michael G.
Nagalla, Srinivasa R.
Lapaire, Olav
author_facet Huhn, Evelyn A.
Hoffmann, Ina
Martinez De Tejada, Begoña
Lange, Soeren
Sage, Kylie M.
Roberts, Charles T.
Gravett, Michael G.
Nagalla, Srinivasa R.
Lapaire, Olav
author_sort Huhn, Evelyn A.
collection PubMed
description BACKGROUND: Preeclampsia is a major pregnancy complication that results in significant maternal and infant mortality, most of which occurs in low and middle-income countries. The accurate and timely diagnosis of preeclampsia is critical in management of affected pregnancies to reduce maternal and fetal/neonatal morbidity and mortality, yet difficulties remain in establishing the rigorous diagnosis of preeclampsia based on clinical parameters alone. Biomarkers that detect biochemical disease have been proposed as complements or alternatives to clinical criteria to improve diagnostic accuracy. This cohort study assessed the performance of several biomarkers, including glycosylated fibronectin (GlyFn), to rule-in or rule-out preeclampsia within 4 weeks in a cohort of women at increased risk for preeclampsia. METHODS: 151 women with risk factors for or clinical signs and symptoms of preeclampsia were selected from a prospective cohort. Maternal serum samples were collected between 20 and 37 weeks of gestation. Clinical suspicion of preeclampsia was defined as presence of new-onset proteinuria, or clinical symptoms of preeclampsia. Subjects with a clinical diagnosis of preeclampsia at the time of enrollment were excluded. GlyFn, pregnancy-associated plasma protein-A2 (PAPPA2), placental growth factor (PlGF), and soluble fms-like tyrosine kinase-1 (sFlt-1) were measured by immunoassay. GlyFn was also determined using a rapid point-of care (POC) test format. Receiver-operating characteristic (ROC) curves derived from logistic regression analysis were used to determine the classification performance for each analyte. RESULTS: 32 of 151 (21%) women developed a clinical diagnosis of preeclampsia within 4 weeks. All biomarkers exhibited good classification performance [GlyFn (area under the curve (AUROC) = 0.94, 91% sensitivity, 86% specificity); PAPPA2 AUC = 0.92, 87% sensitivity, 77% specificity; PlGF AUC = 0.90, 81% sensitivity, 83% specificity; sFlt-1 AUC = 0.92, 84% sensitivity, 91% specificity. The GlyFn immunoassay and the rapid POC test showed a correlation of r = 0.966. CONCLUSIONS: In this prospective cohort, serum biomarkers of biochemical disease were effective in short-term prediction of preeclampsia, and the performance of GlyFn in particular as a POC test may meet the needs of rapid and accurate triage and intervention.
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spelling pubmed-70412572020-03-03 Maternal serum glycosylated fibronectin as a short-term predictor of preeclampsia: a prospective cohort study Huhn, Evelyn A. Hoffmann, Ina Martinez De Tejada, Begoña Lange, Soeren Sage, Kylie M. Roberts, Charles T. Gravett, Michael G. Nagalla, Srinivasa R. Lapaire, Olav BMC Pregnancy Childbirth Research Article BACKGROUND: Preeclampsia is a major pregnancy complication that results in significant maternal and infant mortality, most of which occurs in low and middle-income countries. The accurate and timely diagnosis of preeclampsia is critical in management of affected pregnancies to reduce maternal and fetal/neonatal morbidity and mortality, yet difficulties remain in establishing the rigorous diagnosis of preeclampsia based on clinical parameters alone. Biomarkers that detect biochemical disease have been proposed as complements or alternatives to clinical criteria to improve diagnostic accuracy. This cohort study assessed the performance of several biomarkers, including glycosylated fibronectin (GlyFn), to rule-in or rule-out preeclampsia within 4 weeks in a cohort of women at increased risk for preeclampsia. METHODS: 151 women with risk factors for or clinical signs and symptoms of preeclampsia were selected from a prospective cohort. Maternal serum samples were collected between 20 and 37 weeks of gestation. Clinical suspicion of preeclampsia was defined as presence of new-onset proteinuria, or clinical symptoms of preeclampsia. Subjects with a clinical diagnosis of preeclampsia at the time of enrollment were excluded. GlyFn, pregnancy-associated plasma protein-A2 (PAPPA2), placental growth factor (PlGF), and soluble fms-like tyrosine kinase-1 (sFlt-1) were measured by immunoassay. GlyFn was also determined using a rapid point-of care (POC) test format. Receiver-operating characteristic (ROC) curves derived from logistic regression analysis were used to determine the classification performance for each analyte. RESULTS: 32 of 151 (21%) women developed a clinical diagnosis of preeclampsia within 4 weeks. All biomarkers exhibited good classification performance [GlyFn (area under the curve (AUROC) = 0.94, 91% sensitivity, 86% specificity); PAPPA2 AUC = 0.92, 87% sensitivity, 77% specificity; PlGF AUC = 0.90, 81% sensitivity, 83% specificity; sFlt-1 AUC = 0.92, 84% sensitivity, 91% specificity. The GlyFn immunoassay and the rapid POC test showed a correlation of r = 0.966. CONCLUSIONS: In this prospective cohort, serum biomarkers of biochemical disease were effective in short-term prediction of preeclampsia, and the performance of GlyFn in particular as a POC test may meet the needs of rapid and accurate triage and intervention. BioMed Central 2020-02-24 /pmc/articles/PMC7041257/ /pubmed/32093623 http://dx.doi.org/10.1186/s12884-020-2809-2 Text en © The Author(s). 2020 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Huhn, Evelyn A.
Hoffmann, Ina
Martinez De Tejada, Begoña
Lange, Soeren
Sage, Kylie M.
Roberts, Charles T.
Gravett, Michael G.
Nagalla, Srinivasa R.
Lapaire, Olav
Maternal serum glycosylated fibronectin as a short-term predictor of preeclampsia: a prospective cohort study
title Maternal serum glycosylated fibronectin as a short-term predictor of preeclampsia: a prospective cohort study
title_full Maternal serum glycosylated fibronectin as a short-term predictor of preeclampsia: a prospective cohort study
title_fullStr Maternal serum glycosylated fibronectin as a short-term predictor of preeclampsia: a prospective cohort study
title_full_unstemmed Maternal serum glycosylated fibronectin as a short-term predictor of preeclampsia: a prospective cohort study
title_short Maternal serum glycosylated fibronectin as a short-term predictor of preeclampsia: a prospective cohort study
title_sort maternal serum glycosylated fibronectin as a short-term predictor of preeclampsia: a prospective cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7041257/
https://www.ncbi.nlm.nih.gov/pubmed/32093623
http://dx.doi.org/10.1186/s12884-020-2809-2
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