Supplementary Material for: Comparison of the soluble fms-like tyrosine kinase 1/ placental growth factor-ratio alone versus a multi-marker regression model for the prediction of preeclampsia-related adverse outcomes after 34 weeks of gestation

Introduction: The objective of this retrospective study was to compare the predictive performance of the soluble fms-like tyrosine kinase 1 (sFlt-1) / placental growth factor (PlGF)-ratio alone or in a multi-marker regression model for preeclampsia-related maternal and/or fetal adverse outcomes in women >34 weeks of gestation.
Methods: We analyzed the data collected from 655 women with suspected preeclampsia. Adverse outcomes were predicted by multivariable and univariable logistic regression models. The outcome of patients was evaluated within 14 days after presentation with signs and symptoms of preeclampsia or diagnosed preeclampsia.
Results: The full model integrating available, standard clinical information and the sFlt-1/PlGF-ratio had the best predictive performance for adverse outcomes with an AUC of 72.6%, which corresponds to a sensitivity of 73.3% and specificity of 66.0%. The positive predictive value of the full model was 51.4% and the negative predictive value was 83.5%. 24.5% of patients, who did not experience adverse outcomes but were classified as high risk by sFlt-1/PlGF-ratio (≥38), were correctly classified by the regression model. The sFlt-1/PlGF-ratio alone had a significantly lower AUC of 65.6%.
Conclusions: Integrating angiogenic biomarkers in a regression model improved the prediction of preeclampsia-related adverse outcomes in women at risk after 34 weeks of gestation.

引言：本项回顾性研究旨在比较单独使用可溶性fms样酪氨酸激酶1（soluble fms-like tyrosine kinase 1, sFlt-1）/胎盘生长因子（placental growth factor, PlGF）比值，与多标志物回归模型，对妊娠34周以上女性先兆子痫相关母体和/或胎儿不良结局的预测性能。方法：本研究分析了655名疑似先兆子痫女性的临床数据。采用单变量及多变量逻辑回归模型预测不良结局，在患者出现先兆子痫体征症状或确诊先兆子痫后的14天内评估其结局转归。结果：整合现有标准临床信息与sFlt-1/PlGF比值的全模型对不良结局的预测性能最优，受试者工作特征曲线下面积（Area Under the Curve, AUC）为72.6%，对应灵敏度73.3%、特异度66.0%。该全模型的阳性预测值为51.4%，阴性预测值为83.5%。在24.5%未发生不良结局但被sFlt-1/PlGF比值（≥38）判定为高风险的患者中，回归模型可正确分类。单独使用sFlt-1/PlGF比值的AUC仅为65.6%，显著更低。结论：将血管生成生物标志物整合进回归模型，可改善妊娠34周以上高危女性先兆子痫相关不良结局的预测效能。