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\begin{document}

\title{The prognostic utility of soluble fms-like tyrosine kinase-1 (sFlt-1)
and placental growth factor (PlGF) biomarkers for predicting
preeclampsia: A secondary analysis of data from the INSPIRE trial}



\author[1]{Meron Kifle}%
\author[1]{Prabin  Dahal}%
\author[1]{Manu Vatish}%
\author[1]{Ana Sofia Cerdeira}%
\author[2]{Eric Ohuma}%
\affil[1]{University of Oxford}%
\affil[2]{London School of Hygiene \& Tropical Medicine}%


\vspace{-1em}



  
  \date{June 16, 2024}


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\begin{abstract}
Objective: To compare the prognostic performance of biomarkers soluble
fms-like tyrosine kinase-1 (sFlt-1), Placental Growth Factor (PIGF), and
sFlt-1/PIGF ratio as continuous values or as a binary cut-off of 38 for
predicting preeclampsia (PE) within 7 days. Design: Observational study
using a clinical trial data Setting: Oxford University Hospitals,
Oxford, United Kingdom (UK). Population: Pregnant women between 24+0 to
37+0 weeks of gestation with a clinical suspicion of preeclampsia. Main
outcome: Onset of preeclampsia within seven days of the initial
biomarker test. Methods: Logistic regression models for (i) sFlt-1 (ii)
PlGF, (iii) sFlt-1/PlGF ratio (continuous), and (iv) sFlt-1/PlGF ratio
as a cut-off above or below 38. Results: Of the total 370 women, 42
(11.3\%) developed PE within seven days of screening. Models with sFlt-1
and sFlt-1/PIGF ratio (continuous) had greater overall performance than
models with PIGF or with sFlt-1/PlGF ratio as a cut-off at 38 (R2:
sFlt-1=55\%, PIGF=38\%, sFlt-1/PIGF ratio=57\%, sFlt-1/PlGF ratio as
cut-off at 38 model=46\%). The discriminative performance was highest in
the models with sFlt-1 (c-statistic=0.94) and sFlt-1/PIGF ratio
(continuous) (c-statistic=0.94) compared to PIGF model
(c-statistic=0.87) or sFlt-1/PlGF ratio cut-off at 38
(c-statistic=0.88). Conclusion: Models using values of continuous
sFlt-1/PIGF ratio or sFlt-1 only had better predictive performance
compared to a PIGF only model or the model with sFlt-1/PlGF ratio as a
cut-off at 38. Further studies based on a larger sample size are
warranted to substantiate this finding.%
\end{abstract}%



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