Markedly higher sFlt-1/PlGF ratio in a woman with acute fatty liver of pregnancy compared with HELLP syndrome.

Abstract

AIM:

To compare serum levels of angiogenesis-related factors between 14 women with HELLP (hemolysis, elevated liver enzymes and low platelet count) syndrome and a woman with acute fatty liver of pregnancy (AFLP).

METHODS:

Serum samples were collected in 2004-2008 and 2013-2016. The levels of soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF) were measured by an automated electrochemiluminescence immunoassay using Elecsys sFlt-1 and Elecsys PlGF. After logarithmic transformation, levels of sFlt-1, PlGF and the sFlt-1/PlGF ratio in a woman with AFLP were compared with those in women with HELLP syndrome, using the one-sample t-test.

RESULTS:

At 37 weeks of gestation, a patient was diagnosed with AFLP based on Swansea criteria (showing six features including elevated transaminases), and she also showed a duodenal ulcer with active bleeding, thrombocytopenia and hypertension. Her serum levels of sFlt-1 and sFlt-1/PlGF ratio were significantly higher than in those with HELLP syndrome (273 040 pg/mL vs 15 135 [mean], P < 0.001; 4236 vs 224, P < 0.001; respectively). However, her serum level of PlGF was not significantly different from those with HELLP syndrome.

CONCLUSION:

Serum levels of sFlt-1 and the sFlt-1/PlGF ratio, but not PlGF, in a woman with AFLP were markedly higher than those in women with HELLP syndrome. AFLP may be a different clinical entity from HELLP syndrome based on angiogenesis-related factors. Clinically, the sFlt-1/PlGF ratio may be used to rapidly distinguish AFLP from HELLP syndrome.

• Authors: Hirotada Suzuki, Shiho Nagayama, Chikako Hirashima, Kayo Takahashi, Hironori Takahashi, Manabu Ogoyama, Manabu Nagayama, Koumei Shirasuna, Shigeki Matsubara, Akihide Ohkuchi
• Journal: The journal of obstetrics and gynaecology research (J Obstet Gynaecol Res) Vol. 45 Issue 1 Pg. 96-103 (Jan 2019) ISSN: 1447-0756 [Electronic] Australia
• PMID: 30141235 (Publication Type: Comparative Study, Journal Article)
• Copyright: © 2018 Japan Society of Obstetrics and Gynecology.

Chemical References

• PGF protein, human
• Placenta Growth Factor
• FLT1 protein, human
• Vascular Endothelial Growth Factor Receptor-1

Topics

• Adult
• Fatty Liver (blood)
• Female
• HELLP Syndrome (blood)
• Humans
• Placenta Growth Factor (blood)
• Pregnancy
• Pregnancy Complications (blood)
• Vascular Endothelial Growth Factor Receptor-1 (blood)