Soluble fms-like tyrosine kinase 1 (sFlt-1) - a novel biochemical marker
for acute fatty liver of pregnancy: a prospective observational study
Abstract
Objective Acute fatty liver of pregnancy (AFLP) substantially
contributes to maternal and neonatal morbidity and mortality. The aim of
this study was to investigate angiogenic profiles by measuring soluble
fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PLGF)
in pregnancies compromised by AFLP and to compare them to those
complicated by HELLP (haemolysis, elevated liver enzyme, low platelet)
syndrome. Methods In pregnant patients affected by AFLP or HELLP
syndrome sFlt-1 and PLGF serum levels were measured. To assess the
diagnostic potential of these angiogenic markers in AFLP as well as
discriminating it from HELLP syndrome, non-parametric tests were used
and receiver-operating-curves (ROC) were calculated. Results Six cases
with AFLP and 48 women with HELLP syndrome were included into the study.
Patients with AFLP showed significantly higher sFlt-1 levels (median:
57570pg/ml [range: 31609-147170pg/ml]) than patients with HELLP
syndrome (9713pg/ml [1348-30781pg/ml ; p<0.001). PLGF serum
levels were increased in patients with AFLP compared to those with HELLP
syndrome (197 pg/ml [127-487pg/ml] versus 40 pg/ml [9-644pg/ml],
respectively, p<0.01,). sFlt-1/PLGF-ratios were not
significantly different between AFLP and HELLP syndrome patients (192
[157-1159] versus 232 [3-948], respectively, NS). A sFlt-1
cut-off value of 31100pg/ml allowed differentiating between these two
diseases with a sensitivity and specificity of 100%. Conclusions AFLP
is associated with very high serum levels of sFlt-1. Besides the
suggested Swansea criteria to diagnose AFLP a sFlt-1 value above 31100
pg/ml may be also an additional biochemical feature improving
discrimination between AFLP and HELLP syndrome. Funding:NA
Keywords:AFLP, HELLP syndrome, preeclampsia, sFLT-1, PLGF