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Comment on “Predictive accuracy of sFlt-1/PlGF ratio for preeclampsia and adverse outcomes: prospective, multicenter including primary, secondary, and tertiary care institutions, observational study in Japan”

Hypertension Research volume 48, pages 3063–3064 (2025)Cite this article

We read with great interest the article by Yamazaki et al., published in Hypertension Research, which evaluates the predictive accuracy of the soluble fms-like tyrosine kinase 1 (sFlt-1) to placental growth factor (PlGF) ratio for preeclampsia (PE) and adverse outcomes across primary, secondary, and tertiary care institutions in Japan [1]. This multicenter, prospective observational study provides valuable insights into the utility of the sFlt-1/PlGF ratio in a diverse clinical landscape, particularly in Japan’s unique perinatal care system, where half of deliveries occur in primary facilities lacking neonatal intensive care units (NICUs).

The study’s strength lies in its inclusion of primary care facilities, addressing a gap in prior research, such as the PROGNOSIS Asia study, which primarily focused on tertiary institutions [2]. The reported negative predictive value (NPV) of 98.4% (95% CI, 96.2–99.3) for ruling out PE within 1 week using a cut-off of 38 is impressive and aligns with earlier findings [2, 3]. Notably, the positive predictive value (PPV) for ruling in PE within 4 weeks was higher (48.2%, 95% CI, 38.0–58.5) than in previous studies (e.g., 36.7% in PROGNOSIS and 30.3% in PROGNOSIS Asia) [2, 3], likely due to the higher PE prevalence (20.1%) in this cohort. The improved PPV at a cut-off of 85 (65.0%, 95% CI, 44.1–81.4) supports the authors’ suggestion to consider this threshold for ruling in PE, as corroborated by other studies [4, 5].

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References

  1. Yamazaki T, Cerdeira AS, Teraoka Y, Oomori Y, Mukai Y, Sugimoto J, et al. Predictive accuracy of sFlt-1/PlGF ratio for preeclampsia and adverse outcomes: prospective, multicenter including primary, secondary, and tertiary care institutions, observational study in Japan. Hypertens Res. 2025. https://doi.org/10.1038/s41440-025-02282-0.

  2. Bian X, Biswas A, Huang X, Lee KJ, Li TK, Masuyama H, et al. 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. Hypertension. 2019;74:164–72.

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Author notes

  1. These authors contributed equally: Yuru Fu, Yuanyuan Wang.

Authors and Affiliations

  1. Department of Intensive Care Unit, Fuyang People’s Hospital of Anhui Medical University, Fuyang, China

    Yuru Fu

  2. Department of Cardiology, Fuyang People’s Hospital of Anhui Medical University, Fuyang, China

    Yuanyuan Wang

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  1. Yuru Fu
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  2. Yuanyuan Wang
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Correspondence to Yuanyuan Wang.

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Fu, Y., Wang, Y. Comment on “Predictive accuracy of sFlt-1/PlGF ratio for preeclampsia and adverse outcomes: prospective, multicenter including primary, secondary, and tertiary care institutions, observational study in Japan”. Hypertens Res 48, 3063–3064 (2025). https://doi.org/10.1038/s41440-025-02377-8

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