# Assessment of the Values of Endoglin and Soluble Fms-Like Tyrosine Kinase-1/Placental Growth Factor Ratio Among Women at Risk for Pre-eclampsia: A Cross-Sectional Study

## TL;DR

This study shows that high levels of endoglin and sFlt-1/PlGF ratio in blood can help identify pregnant women at high risk for pre-eclampsia.

## Contribution

The study demonstrates the potential of endoglin and sFlt-1/PlGF ratio as early biomarkers for pre-eclampsia risk in pregnant women.

## Key findings

- Serum endoglin and sFlt-1/PlGF ratio levels were significantly higher in high-risk women compared to controls.
- The combination of endoglin and sFlt-1/PlGF ratio showed 100% sensitivity and 71.9% specificity for detecting pre-eclampsia risk.
- Elevated levels of these biomarkers were strongly associated with pre-eclampsia risk at 24 to 28 weeks of gestation.

## Abstract

Background: Preeclampsia (PE) is a common complication of pregnancy affecting pregnant women and newborns. PE causes multi-organ disorders and remains one of the main reasons for maternal morbidity and mortality. In addition, PE leads to many complications that can occur in the fetus or newborn.

Objectives: This study aimed to evaluate the serum endoglin and soluble fms-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) ratio in pregnant women at high risk for PE and normal pregnant women and to assess the sensitivity and specificity of endoglin and SFlt-1/PlGF ratio.

Methodology: A cross-sectional and purposive sampling study was conducted in the Department of Obstetrics and Gynaecology, Sree Balaji Medical College and Hospital, Chrompet, Chennai, a tertiary care hospital in India, from June 2024 to May 2025 for a period of one year. Pregnant women in 24 to 28 weeks of gestation, as calculated by the LMP (last menstrual period) and dating scans, were included in the study. The following were excluded from this study: pregnant women beyond 28 weeks of gestation, pre-eclampsia, hematological disorders, autoimmune disorders, hepatitis, fever, and any systemic infection. Blood samples were collected and used for the analysis of serum endoglin, sFlt-1, PlGF, renal function test (RFT), and liver function test (LFT). Diagnostic accuracy of the biomarkers was assessed by calculating sensitivity, specificity, positive predictive value, negative predictive value, and ROC curve using MedCalc version 15.0 (MedCalc Software, Ostend, Belgium).

Results: In this research, 114 patients were included. Of them, 57 were at high risk for PE, and 57 were considered to be in the control group. The average age of those who took part in the case study was 26.4 ± 4.36 years, while the average age of those who served as controls was 25.73 ± 4.11 years, with ages ranging from 18 to 35. The body mass index (BMI), mean arterial pressure (MAP), and number of primigravida are increased in high-risk groups. Serum endoglin and SfLT-1/PlGF ratio levels were significantly increased in high-risk patients for PE, when compared to the control group.

Conclusion: This study highlights the clinical significance of serum endoglin and sFlt-1/PlGF ratio levels in women at high risk for PE. Elevated serum endoglin and SFlt-1/PlGF ratio levels were found to be strongly associated with women at high risk for PE. Hence, it can be used as a potential biomarker for detecting the high risk for PE at 24 to 28 weeks. This study suggested that using a combination of the above two markers (endoglin and Sflt-1/PGLF ratio) will have a high sensitivity of 100% (43.7-100) and a specificity of 71.9% (58.9-82.3).