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Clinical Chemistry 48: 1418-1425, 2002;
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(Clinical Chemistry. 2002;48:1418-1425.)
© 2002 American Association for Clinical Chemistry, Inc.

Predictive Value of Routine Circulating Soluble Endothelial Cell Adhesion Molecule Measurements during Pregnancy

Thomas Krauss1, Günter Emons1, Walther Kuhn1 and Hellmut G. Augustin1,2a

1 Cell Biology Laboratory, Department of Gynecology and Obstetrics, University of Göttingen Medical School, 37075 Göttingen, Germany.

2 Department of Vascular Biology & Angiogenesis Research, Tumor Biology Center, 79106 Freiburg, Germany.

aAddress correspondence to this author at: Department of Vascular Biology & Angiogenesis Research, Tumor Biology Center, Breisacher Strasse 117, D-79106 Freiburg, Germany. Fax 49-761-206-1505; e-mail augustin{at}angiogenese.de.

Background: The present study was aimed at determining whether routine prenatal measurements of circulating soluble intercellular adhesion molecule (sICAM-1; CD54) and soluble vascular cell adhesion molecule (sVCAM-1; CD106) in midgestation have predictive value for the identification of pregnant women destined to develop preeclampsia or other complications of pregnancy during late gestation.

Methods: Plasma sICAM-1 and sVCAM-1 were analyzed between weeks 22 and 29 of gestation in 1543 pregnant women and related to the outcome of pregnancy in a prospective longitudinal study.

Results: Plasma sICAM-1 and sVCAM-1 in uncomplicated pregnancies were normally distributed and varied over a small range (sICAM-1, SD = 22.5%; sVCAM-1, SD = 25.5%). Of all analyzed uncomplicated pregnancies, 54 (3.95%) were identified with concentrations of sICAM-1 or sVCAM-1 above the mean + 2 SD. In contrast, of 177 pregnancies with complications (prevalence, 11.5%), 97 (55%) had sICAM-1 or sVCAM-1 concentrations above the same cutoffs weeks before the onset of disease. The sensitivities of sICAM-1 and sVCAM-1 measurements were 66% for preeclampsia and hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome), 42% for gestational hypertension, 50% for fetal retardation, 46% for preterm labor, 50% for gestational diabetes mellitus, 67% for gestational proteinuria, and 70% for infections during pregnancy. Taken together, routine prenatal sICAM-1 and sVCAM-1 measurements had an overall predictive value of 64%.

Conclusions: Midgestation measurements of circulating sICAM-1 and sVCAM-1 have a high predictive value (area under the curve of combined sICAM-1 and sVCAM-1 measurements determined by ROC analysis, 0.85) and may identify up to 55% of pregnant women who will later develop a severe pregnancy-related complication.




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