Clinical significance of ratio of soluble fms-like tyrosine kinase-1 and placenta growth factor to prospectively predict preeclampsia: a meta-analysis

Objective To investigate the clinical significance of blood soluble fms-like tyrosine kinase-1（sFlt-1）/placenta growth factor（PlGF） ratio for prospectively predicting preeclampsia（PE） by meta-analysis. Methods PubMed, ResearchGate, Embase and WanFang databases were searched up to April 2018. Main inclusion criteria: ①prospective studies which enrolled both PE and no-PE population, ②blood sFlt-1/PlGF ratio must be tested before the diagnosis of PE, ③studies must provide or give enough data of true positive, false positive, false negative and true negative events numbers. Heterogeneity was evaluated using the Q-test and I~2 statistic. The odds ratios were pooled using bivariate mixed-effects logistic regression modeling. Results Twelve studies with 9261 pregnant women（622 PE and 8639 non-PE） were included. Heterogeneity was substantial: I~2=97%（95% CI 94%-99%）, Q=57.70, P＜0.01. The pooled sensitivity and specificity were 83%（95% CI 73%-89%） and 87%（95% CI 80%-92%）, respectively. The pooled positive likelihood ratio and negative likelihood ratio were 6.4（95% CI 4.0-10.3） and 0.20（95% CI 0.12-0.32）, respectively. The pooled diagnostic odds ratio was 27.60（95% CI 10.36-73.67）. Deeks funnel plots showed no obvious publishing bias（P＞0.05）. Area under curve（AUC） of summary receiver operating characteristic curve（SROC） was 0.92（95% CI 0.89-0.94）. Conclusion The ratio of blood sFlt-1/PlGF is a promising method to predict PE. Further large-scale cohort studies are needed to verify its validity.