Blood test may predict severe preeclampsia risk for women in labor
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Key takeaways:
- Fibrinogen-to-albumin ratio accurately predicted severe preeclampsia risk for laboring women.
- The measurement could serve as a tool for anesthesiologists.
A blood test to measure fibrinogen-to-albumin ratio predicted preeclampsia and severe preeclampsia risk in laboring women compared with other blood markers, potentially providing a useful tool for anesthesiologists, researchers reported.
Findings from the preliminary study were presented at the American Society of Anesthesiologists’ ANESTHESIOLOGY annual meeting in Philadelphia.
“We know preeclampsia is an inflammatory condition that affects up to 10% of pregnant women, potentially leading to many complications during and after pregnancy,” Lucy Shang, BA, a medical student at the Icahn School of Medicine at Mount Sinai and lead author of the study, told Healio. “There have not been lot of accessible and reliable markers clinicians can refer to when evaluating the risk and the severity of preeclampsia. This is important, especially for anesthesiologists upon admission for labor to see if the patient is at risk for preeclampsia, because that can lead to complications with anesthesia delivery.”
Measuring inflammation
Fibrinogen-to-albumin ratio (FAR) is calculated from serum levels of fibrinogen and albumin measured during routine exams, and previous studies suggest it is a useful marker for predicting the prognosis of patients with a variety of inflammatory conditions, according to Daniel Katz, MD, associate professor and vice chair of education for the department of anesthesiology, pain and perioperative medicine at the Icahn School of Medicine at Mount Sinai. There is no universally established normal value for FAR, which can range from 0.05 to 1 or higher. Higher FAR values are often associated with increased inflammation, infection or serious health conditions.
“We know fibrinogen is related to inflammation, and higher values of fibrinogen are more indicative of higher inflammatory states in the body,” Katz told Healio. “Albumin is more related to fluid balance in the body; lower albumin can signal fluid imbalance and liver dysfunction.”
For the single-center retrospective study, researchers analyzed data from 2,629 women who gave birth between 2018 and February 2024, stratified by preeclampsia phenotype: women without preeclampsia (controls; n = 1,819); preeclampsia with mild features (n = 584) and preeclampsia with severe features (n = 226). All women had fibrinogen and albumin measurements available upon admission for labor, as well as measurements of hemoglobin, alanine aminotransferase (ALT) and aspartate aminotransferase (AST).
“We were looking for markers that were readily available and relatively inexpensive,” Katz told Healio. “There are some screening tests for preeclampsia that can happen early on in pregnancy that tell you about your risk for later in pregnancy, but they tend to be expensive and insurance does not necessarily cover them. The nice thing about the test that we are running is it is a ratio of two commonly performed blood tests, easily obtained and available for people to use. Our sample includes women who already had these lab tests performed anyway.”
Tool for earlier interventions
Across the three groups, race (P < .001) and mean age (P = .032) differed; BMI, systolic blood pressure and diastolic BP were higher in the severe preeclampsia group compared with controls and the mild preeclampsia groups (P < .001). Mean gestational age was lower among women in the severe preeclampsia group (P < .001).
Researchers found that fibrinogen (OR = 1.2; 95% CI, 1.11-1.28; P < .001), FAR (OR = 68.48; 95% CI, 14.54-322.44; P < .001), hemoglobin (OR = 0.9; 95% CI, 0.84-0.96; P = .001), ALT (OR = 3.93; 95% CI, 2.7-5.73; P < .001) and AST (OR = 3.65; 95% CI, 2.55-5.22; P < .001) were independent risk factors for the development of any preeclampsia. However, only FAR was an independent risk factor for severe preeclampsia (OR = 18.49; 95% CI, 1.7-200.67; P = .017).
In a model adjusting for hemoglobin, ALT, AST, age, race, gravidity, and multiple gestations, FAR predicted any preeclampsia (OR = 32.77; 95% CI, 6.72-159.92; P < .001) and severe preeclampsia (OR = 11.22; 95% CI, 1.03-122.35; P = .047), as did Black race for both any preeclampsia (OR = 1.77; 95% CI, 1.41-2.23; P < .001) and severe preeclampsia (OR = 1.5; 95% CI, 1.03-2.16; P = .032).
Receiver operating characteristic analysis for severe preeclampsia shower FAR had the highest area under the operating curve value of 0.546 (95% CI, 0.506-0.587; P = .01) compared with other markers, surpassed only by the researchers’ model, Shang said (AUC = 0.577; 95% CI, 0.536-0.617; P < .001).
“This was a preliminary analysis and we are working on collecting a more complete dataset,” Shang told Healio. “With further research, if this ratio still holds its value, this could be a tool anesthesiologists can use to evaluate women in labor and prompt earlier interventions like magnesium sulfate or more monitoring of BP and fluid values.”
For more information:
Daniel Katz, MD, can be reached at daniel.katz@mountsinai.org.
Lucy Shang, BA, can be reached at lucy.shang@icahn.mssm.edu.