{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T22:34:09Z","timestamp":1791412449839,"version":"4.3.3"},"reference-count":31,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2022,2,24]],"date-time":"2022-02-24T00:00:00Z","timestamp":1645660800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>We investigated the impact of the soluble fms-like tyrosine kinase 1 (sFlt-1)\/placental growth factor (PlGF) ratio to predict short-term risk of preeclampsia on clinical utility and healthcare resource utilisation using real-world data (RWD), and compared findings with health economic modelling from previous studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods and findings<\/jats:title>\n                    <jats:p>This retrospective analysis compared data from the German population of a multicentre clinical study (PROGNOSIS, n = 203; sFlt-1\/PlGF ratio blinded and unavailable for decision-making) with RWD from University Hospital Leipzig, Germany (n = 281; sFlt-1\/PlGF ratio used to guide clinical decision-making). A subgroup of the RWD cohort with the same inclusion criteria as the PROGNOSIS trial (RWD prediction only, n = 99) was also included. sFlt-1\/PlGF ratio was measured using fully automated Elecsys\u00ae sFlt-1 and PlGF immunoassays (cobas e analyser; Roche Diagnostics).<\/jats:p>\n                    <jats:p>A similar proportion of women in the RWD and PROGNOSIS cohorts experienced preeclampsia (14.95% vs. 13.79%; p = 0.7938); a smaller proportion of women in the RWD prediction only cohort experienced preeclampsia versus PROGNOSIS (6.06%; p = 0.0526). In women with preeclampsia, median gestational age at delivery (weeks) was comparable in the RWD and PROGNOSIS cohorts (34.0 vs. 34.3, p = 0.5895), but significantly reduced in the RWD prediction only cohort versus PROGNOSIS (27.1, p = 0.0038). sFlt-1\/PlGF ratio at baseline visit was not statistically significantly different for the RWD and PROGNOSIS cohorts, irrespective of preeclampsia outcome. Hospitalisations for confirmed preeclampsia were significantly shorter in the RWD cohort versus PROGNOSIS (median 1 vs. 4 days, p = 0.0093); there was no significant difference between RWD prediction only and PROGNOSIS (3 days, p = 0.9638). All-cause hospitalisations were significantly shorter in the RWD (median 1 day; p&lt;0.0001) and RWD prediction only (1 day; p&lt;0.0001) cohorts versus PROGNOSIS (3 days).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study supports the findings of previous studies, showing that routine clinical use of the sFlt-1\/PlGF ratio may result in shorter duration of hospitalisations, with potential economic benefits.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0263443","type":"journal-article","created":{"date-parts":[[2022,2,24]],"date-time":"2022-02-24T13:40:07Z","timestamp":1645710007000},"page":"e0263443","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":30,"title":["sFlt-1\/PlGF ratio for prediction of preeclampsia in clinical routine: A pragmatic real-world analysis of healthcare resource utilisation"],"prefix":"10.1371","volume":"17","author":[{"given":"Anne","family":"Dathan-Stumpf","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Rieger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Verlohren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cyrill","family":"Wolf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1264-7365","authenticated-orcid":true,"given":"Holger","family":"Stepan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,2,24]]},"reference":[{"issue":"1","key":"pone.0263443.ref001","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ejogrb.2013.05.005","article-title":"Global and regional estimates of preeclampsia and eclampsia: a systematic review","volume":"170","author":"E Abalos","year":"2013","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"pone.0263443.ref002","unstructured":"Guideline of the German Society of Gynecology and Obstetrics: Hypertensive Pregnancy Disorders: Diagnosis and Therapy. (S2k-Level, AWMF Registry No. 015\/018) 2019. Available from: https:\/\/www.awmf.org\/uploads\/tx_szleitlinien\/015-018l_S2k_Diagnostik_Therapie_hypertensiver_Schwangerschaftserkrankungen_2019-07.pdf."},{"issue":"1","key":"pone.0263443.ref003","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1161\/HYPERTENSIONAHA.117.10803","article-title":"Hypertensive disorders of pregnancy: ISSHP classification, diagnosis, and management recommendations for international practice","volume":"72","author":"MA Brown","year":"2018","journal-title":"Hypertension"},{"key":"pone.0263443.ref004","unstructured":"American College of Obstetricians and Gynecologists. ACOG Practice Bulletin no. 222. Gestational hypertension and preeclampsia. 2020. Available from: https:\/\/www.acog.org\/clinical\/clinical-guidance\/practice-bulletin\/articles\/2020\/06\/gestational-hypertension-and-preeclampsia."},{"issue":"1","key":"pone.0263443.ref005","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1097\/AOG.0000000000003021","article-title":"ACOG Practice Bulletin no. 203 summary: chronic hypertension in pregnancy","volume":"133","author":"American College of Obstetricians and Gynecologists","year":"2019","journal-title":"Obstet Gynecol"},{"issue":"1","key":"pone.0263443.ref006","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.semnephrol.2010.10.004","article-title":"Angiogenic factors and preeclampsia","volume":"31","author":"SE Maynard","year":"2011","journal-title":"Semin Nephrol"},{"issue":"7627","key":"pone.0263443.ref007","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1136\/bmj.39335.385301.BE","article-title":"Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis","volume":"335","author":"L Bellamy","year":"2007","journal-title":"BMJ"},{"issue":"10","key":"pone.0263443.ref008","doi-asserted-by":"crossref","first-page":"1625","DOI":"10.3390\/jcm8101625","article-title":"Preeclampsia: risk factors, diagnosis, management, and the cardiovascular impact on the offspring","volume":"8","author":"R Fox","year":"2019","journal-title":"J Clin Med"},{"issue":"7539","key":"pone.0263443.ref009","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1136\/bmj.332.7539.463","article-title":"Management of pre-eclampsia","volume":"332","author":"L Duley","year":"2006","journal-title":"BMJ"},{"issue":"2","key":"pone.0263443.ref010","first-page":"261","article-title":"Prediction of adverse outcomes by common definitions of hypertension in pregnancy","volume":"97","author":"J Zhang","year":"2001","journal-title":"Obstet Gynecol"},{"issue":"7","key":"pone.0263443.ref011","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1056\/NEJMoa031884","article-title":"Circulating angiogenic factors and the risk of preeclampsia","volume":"350","author":"RJ Levine","year":"2004","journal-title":"N Engl J Med"},{"issue":"6","key":"pone.0263443.ref012","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1016\/j.ajog.2004.03.043","article-title":"Evidence supporting a role for blockade of the vascular endothelial growth factor system in the pathophysiology of preeclampsia. 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endothelial growth factor receptor 1 (sVEGFR-1) levels in women with preeclampsia","volume":"88","author":"K Koga","year":"2003","journal-title":"J Clin Endocrinol Metab"},{"issue":"22","key":"pone.0263443.ref016","doi-asserted-by":"crossref","first-page":"10705","DOI":"10.1073\/pnas.90.22.10705","article-title":"Inhibition of vascular endothelial cell growth factor activity by an endogenously encoded soluble receptor","volume":"90","author":"RL Kendall","year":"1993","journal-title":"Proc Natl Acad Sci U S A"},{"issue":"5","key":"pone.0263443.ref017","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1161\/HYPERTENSIONAHA.111.00250","article-title":"Redefining preeclampsia using placenta-derived biomarkers","volume":"61","author":"AC Staff","year":"2013","journal-title":"Hypertension"},{"key":"pone.0263443.ref018","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1186\/1471-2393-14-324","article-title":"Multicenter prospective clinical study to evaluate the prediction of short-term outcome in pregnant women with suspected preeclampsia (PROGNOSIS): study protocol","volume":"14","author":"M Hund","year":"2014","journal-title":"BMC Pregnancy Childbirth"},{"issue":"1","key":"pone.0263443.ref019","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1056\/NEJMoa1414838","article-title":"Predictive value of the sFlt-1:PlGF ratio in women with suspected preeclampsia","volume":"374","author":"H Zeisler","year":"2016","journal-title":"N Engl J Med"},{"issue":"3","key":"pone.0263443.ref020","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1002\/uog.14799","article-title":"Implementation of the sFlt-1\/PlGF ratio for prediction and diagnosis of pre-eclampsia in singleton pregnancy: implications for clinical practice","volume":"45","author":"H Stepan","year":"2015","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"1","key":"pone.0263443.ref021","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1161\/HYPERTENSIONAHA.119.12760","article-title":"Short-term prediction of adverse outcomes using the sFlt-1 (soluble fms-like tyrosine kinase 1)\/PlGF (placental growth factor) ratio in Asian women with suspected preeclampsia","volume":"74","author":"X Bian","year":"2019","journal-title":"Hypertension"},{"issue":"3","key":"pone.0263443.ref022","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1016\/j.preghy.2016.08.009","article-title":"8 The sFlt-1\/PlGF ratio can rule out preeclampsia for up to four weeks in women with suspected preeclampsia: risk factors, prediction of preeclampsia","volume":"6","author":"S Verlohren","year":"2016","journal-title":"Pregnancy Hypertens"},{"issue":"2","key":"pone.0263443.ref023","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1161\/HYPERTENSIONAHA.120.15146","article-title":"Prediction of preeclampsia-related adverse outcomes with the sFlt-1 (soluble fms-like tyrosine kinase 1)\/PlGF (placental growth factor)-ratio in the clinical routine: a real-world study","volume":"77","author":"LA Dr\u00f6ge","year":"2021","journal-title":"Hypertension"},{"key":"pone.0263443.ref024","article-title":"Real-world data on the clinical use of the sFlt-1\/PlGF ratio in pregnancies with placental dysfunction","author":"A Dathan-Stumpf","year":"2021","journal-title":"AJOG"},{"issue":"2","key":"pone.0263443.ref025","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1111\/1471-0528.16383","article-title":"Added prognostic value of longitudinal changes of angiogenic factors in early-onset severe pre-eclampsia: a prospective cohort study","volume":"128","author":"A Peguero","year":"2021","journal-title":"BJOG"},{"issue":"6","key":"pone.0263443.ref026","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1002\/uog.15997","article-title":"sFlt-1\/PlGF ratio test for pre-eclampsia: an economic assessment for the UK","volume":"48","author":"M Vatish","year":"2016","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"1","key":"pone.0263443.ref027","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1186\/s12913-018-3406-1","article-title":"Economic assessment of the use of the sFlt-1\/PlGF ratio test to predict preeclampsia in Germany","volume":"18","author":"D Schlembach","year":"2018","journal-title":"BMC Health Serv Res"},{"key":"pone.0263443.ref028","unstructured":"NICE. PlGF-based testing to help diagnose suspected pre-eclampsia (Triage PlGF test, Elecsys immunoassay sFlt-1\/PlGF ratio, DELFIA Xpress PlGF 1-2-3 test, and BRAHMS sFlt-1 Kryptor\/BRAHMS PlGF plus Kryptor PE ratio). 2016. Available from: https:\/\/www.nice.org.uk\/guidance\/dg23\/resources\/plgfbased-testing-to-help-diagnose-suspected-preeclampsia-triage-plgf-test-elecsys-immunoassay-sflt1plgf-ratio-delfia-xpress-plgf-123-test-and-brahms-sflt1-kryptorbrahms-plgf-plus-kryptor-pe-ratio-pdf-1053688576453."},{"issue":"1","key":"pone.0263443.ref029","doi-asserted-by":"crossref","first-page":"IX","DOI":"10.3109\/10641950109152635","article-title":"The classification and diagnosis of the hypertensive disorders of pregnancy: statement from the International Society for the Study of Hypertension in Pregnancy (ISSHP)","volume":"20","author":"MA Brown","year":"2001","journal-title":"Hypertens Pregnancy"},{"key":"pone.0263443.ref030","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1097\/AOG.0000000000001525","article-title":"Soluble fms-like tyrosine kinase-1-to-placental growth factor ratio and time to delivery in women with suspected preeclampsia","volume":"128","author":"H Zeisler","year":"2016","journal-title":"Obstet Gynecol"},{"key":"pone.0263443.ref031","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/j.ejogrb.2014.04.033","article-title":"Care-as-usual provided to formerly preeclamptic women in the Netherlands in the next pregnancy: health care consumption, costs and maternal and child outcome","volume":"179","author":"DHJ Delahaije","year":"2014","journal-title":"Eur J Obstet Gynecol Reprod Biol"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0263443","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,24]],"date-time":"2022-02-24T13:40:35Z","timestamp":1645710035000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0263443"}},"subtitle":[],"editor":[{"given":"George","family":"Vousden","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,2,24]]},"references-count":31,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,2,24]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0263443","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,24]]}}}