PP176. SFLT-1: A possibility of precocious diagnosis of preeclampsia

Introduction: Preeclampsia (PE) affects 5-8% of all pregnant women and can trigger a severe gestational hypertension framework and eventually develop into eclampsia and HELLP syndrome. Anticipating the damage would be important in order to establish procedures that can reduce adverse outcomes. For this reason, many researches are undertaken to identify ways to make a diagnosis of preeclampsia as early as possible. It has been highlighted in literature the study: the sFlt1 (soluble fms-like tyrosine kinase-1) has been implicated in the precocious diagnosis of pre eclampsia. The sFlt1 is an anti-angiogenic factor produced in response to oxidative stress derived from the deleterious effects of pre-eclampsia.

Objectives: The objective of the study was to evaluate the role of Soluble fms-like tyrosine kinase-1 in the diagnosis of preeclampsia.

Methods: This is a review conducted in the database PubMed and Lilacs. For this purpose, we used the following MeSH, "Vascular Endothelial Growth Factor Receptor-1" OR "FLT1 protein, human" AND "Pre-Eclampsia/diagnosis" in PubMed and "Pre-eclampsia" AND "SFLT1A" in Lilacs, resulting in 84 papers. After reading the abstracts of these studies, we selected the articles analyzed taking into consideration the criteria for inclusion and exclusion. We excluded publications that were not in the period under study (2008 to July 2011) and by study design. Including only case-control, cohort and prospective observational. For a critical analysis of the material, we used the following indicators: researcher, years, central theme, participants, study design and primary outcome.

Results: The final results of this study were composed of seven articles and are shown for each target outcome. These vary according to gestational age at which PE is installed and the marker studied (sFlt1 alone or its relation to PlGF - sFlt1/PIGF). Six studies showed greater levels of sFlt1 for the preeclampsia groups when compared to the control group. Significantly differences in antiangiogenic factors seric levels were not found among preeclamptic and eclamptic patients. When associated with another factor, like PIGF, a greater efficacy in the diagnosis of early preeclampsia is shown. Of the studies analyzed, only one (Lynch et al) showed no significant difference between the values of sFlt-1 in groups of early PE, late PE and control for gestational ages between 10 and 15 weeks. As for the relation sFlt-1/PIGF, five studies have considered it even better for PE diagnosis when compared to sFlt-1 isolated.

Conclusion: The dosage of sFlt1 may be a relevant resource for the early diagnosis of preeclampsia before the installation of target organ damage, especially if measured in the period between 12 and 28 weeks of gestational age. Whereas sFlt-1 manifests itself before the 20th week, that may be interesting clinical point of view since it is this phase that settles the most severe cases, when the adoption of care could prevent further risks. The relationship sFlt1/PIGF, was more appropriate than the measurement of sFlt1 alone. Additional studies are needed to: amplification of the number of women evaluated, establishing gestational age appropriate for study, serum standard and need to consider the relationship between sFlt1 and other factors pro and/or anti-angiogenic.