Rev. Med. Chir. Soc. Med. Nat., Ia și 2015 vol. 11 9, no. 2 [600289]

Rev. Med. Chir. Soc. Med. Nat., Ia și – 2015 – vol. 11 9, no. 2
BASIC SCIENCES ORIGINAL PAPERS
473 THE CORRELATION BETWEEN MARKERS OF SYSTEMIC
INFLAMMATION AND ANGIOGENIC MARKERS IN PRE -ECLAMPSIA
Elena Mih ălceanu1, D. Nemescu 1 Maria Gavriluț³,
Daniela Cristina Dimitriu2, Alexandra Pangal1, M. Onofriescu1
Univ ersity of Medicine and Pharmacy ”Grigore T. Popa” – Iasi
Faculty of Medicine
1. Department of Mother and Child Medicine
2. Department of Morpho -Functional Sciences
3. Department of Surgery
*Corresponding author. E-mail: [anonimizat]
THE CORRELATION BETWEEN MARKERS OF SYSTEMIC INFLAMMATION AND
ANGIOGENIC MARKERS IN PRE -ECLAMPSIA (Abstract): Pre-eclampsia is a severe mult i-
systemic syndrome that represents a major cause of maternal, foetal and neonatal mortal ity and
morbidity. In the study we conducted it stood out the significant modifications of angiogenic
markers in pregnant women suffering from pre -eclampsia and the existence of a correlation b e-
tween C -reactive protein (CRP) and SBP, DBP and average BP. Material and method: The
group included in the study consisted of 138 pregnant women hospitalized at the “Cuza -Voda”
Clinical Hospital of Obstetrics and Gynaecology of Iasi, between 2012 -2014, with over 20
weeks gestational age and which gave their free cons ent to take part in the study. Results: It is
confirmed the importance of determining the markers for diagnosing and monitoring hyperte n-
sive pregnant women and at the same time it was pointed out that the sFlt -1/PlGF ratio repr e-
sents a good pre-eclampsia p redictor . Conclusions: The results of our study confirm the i m-
portance of determining sFlt -1 and PlGF as markers for diagnosing and monitoring pregnant
women with HBP as well as the sFlt -1/ PlGF ratio which represents a good pre -eclampsia pr e-
dictor. Keywor ds: MOLECULAR MARKERS, PRE -ECLAMPSIA, PLACENTAL DY S-
FUNCTIONS, ENDOTHELIAL DYSFUNCTION, HELP SYNDROME.
Preeclampsia represents a pathologic
condition specific to the pregnancy period,
with an incidence of 3 -5%, characterized
by de novo hypertension and significant
proteinuria (>300mg/24h), that frequently
begins after the 20th gestational week. It is
a syst emic vascular disease that can affect
numerous organs leading to severe compl i-
cations for both the mother and the fetus .
Although the exact causes that determine
the apparition of pre -eclampsia are not known, it was noticed that placental dy s-
functions play a key role in its apparition,
being correlated with the subsequent m a-
ternal endothelial dysfunction (1 -5).
The low vascularization of the uterus
leads to the deficitary development of the
fetus , with consequences on its further d e-
velopment (6, 7, 8). The clinical manifest a-
tions can vary from mild to severe forms,
reaching its peak with the HELLP syndrome
(haemolysis, growth of hepatic enzymes and

Elena Mihalceanu et al.
474 thrombocytopenia) and eclampsia (appar i-
tion of convulsive crises) (6, 9).
In Romania, the annual incidence of
preeclampsia cases is between 6 -14%, va r-
ying between 10 and 14% at primiparas and
5.7-7.3% at multiparas with a significantly
increased incidence of preeclampsia cases
in women with gemelar / multiple pregna n-
cy, in the one with pre -eclampsia at prev i-
ous pre gnancies, in primiparas under 20
and over 35 years (20).
Considering the prevalence of this di s-
order, especially in developed countries,
the existence of a validated biological
marker allows a more careful supervision
of asymptomatic patients so to anticip ate
complications with lethal risk. An ideal
biological marker should have: high sens i-
tivity and specificity level, predictive c a-
pacity for the prognostic and the evolution
of the disorder as well as for the response
to treatment, low accessibility and inv asive
level for collecting; its testing should be
simple, effective and cheap.
C-reactive protein (CRP) is considered a
sensitive marker of endothelial dysfunction
and inflammation (10), but there are dive r-
gent opinions when referring to the value of
CRP as a pre -eclampsia marker (11).
This study focused on assessing the
clinical and progressive aspects of pre –
eclampsia, by checking the correlation
between inflammatory parameters, repr e-
sented by C -reactive protein and blood
pressure, on a group of pregnant women
with pre -eclampsia and pregnancy induced
hypertension (PIH) compared to a group of
normal pregnant women. At the same time,
it was intended to create a mathematic
model to associate a predictor factor as
PlGF, sFLT -1 or the PlGF/sFLT -1 ratio
with th e clinical parameters assessed in
pregnant women with pre -eclampsia. MATERIAL AND METHOD S
This was a retrospective, case -control
type of study and focused on studying the
clinical -progressive aspects of PE, by
checking the correlation between the i n-
flammatory parameters, represented by
CRP and blood pressure, in a group of
pregnant women with pre -eclampsia and
PIH compared to a group of normal pre g-
nant women. 138 pregnant women hospita l-
ized at the “Cuza -Vodă ” Clinical Hospital
of Obstetrics and Gynec ology of Iasi were
selected, between 2012 -2014, with over 20
of weeks gestational age, which requested a
specialized consultation and gave their free
consent to take part in the study. At the
same time, the study received the approval
from the hospital’s e thics commission.
These patients were collected biological
samples to determine their CRP not being
the case of an infectious situation or spo n-
taneous premature rupture of membranes.
At the same time, there have also been
determined the PlGF and sFlt -1 bio markers
and it was calculated the sFlt -1/ PlGF ratio,
as a prognosis instrument for the patient
with pre -eclampsia, depending of the infl u-
ence of the cumulative risk factors.
The criteria for including them into the
study group were: gestational age > 20
weeks; high blood pressure and proteinuria;
the exclusion criteria were: gestational age
< 20 weeks; high blood pressure pre –
existent to pregnancy; spontaneous rupture
of membranes; associated infectious p a-
thology (chorioamnionitis, urinary infe c-
tions, res piratory infections ), seropositivity
to HIV.

RESULTS AND DISCUSSION
Lab analyses. Hematological and bi o-
logical investigations were conducted in
the laboratory of medical analyses from the

The correlation between markers of systemic inflammation and angiogenic markers
in pre -eclampsia
475 “Cuza Vod a” Maternity of Iasi, while the
immunological ones were con ducted within
the Immunology laboratory from the “Sf.
Spiridon” University Hospital of Iasi. For
the hematological investigations total blood
was used, collected on K 3EDTA type ant i-
coagulant using an automatic hematology
analyzer (Celltac MEK – 6318K). The bio-
chemical investigations used serum o b-
tained after collecting the blood into “clot
activator” type test tubes and spinning it at
4000 rpm, for 10 minutes. In determining
the biochemical parameters it was used an
automatic analyzer of Clinical chemistry,
RX Imola model, along with calibrators
and control serums. The immunological
investigations were made for the C reactive
protein using the chemiluminescence tec h-
nique and a IMMULITE 2000 type aut o-
mat, while for the PlGF and sFlt -1 markers,
it was used the chemiluminescence tec h-
nique with the COBAS E411 ROCHE an a-
lyser. The detection limits for PlGF -1 were
between 1 -1.500 pg/ml, and for sFlt -1 were
between 100 -30.000 pg/ml. Proteinuria was
determined from the urine samples collec t-
ed upon hospitalization, usi ng the VITROS
950 dry chemistry automatic analyzer and
diluting the samples accordingly.
A clinical picture was made for each
woman. It was recorded the height of the
pregnant woman and the evolution of the
weight during the pregnancy period. The
dates and the hours of the results of the
collected proteinuria were recorded in 24
hours, where appropriate. The markers of
the inflammatory process were determined
(CRP). At the same time, there were regi s-
tered the dates and the hours when the
highest blood press ure values were recor d-
ed during the pregnancy. By monitoring the
blood pressure value, in the previous cha p-
ter, there were pointed out the correlations between the markers of systemic inflamm a-
tion and cardiovascular risk.
Laboratory tests were conducted on all
pregnant women, the blood tests being
focused on the parameters of the hepatic
function (TGO, TGP, bilirubin, LDH) and
renal function (urea, creatinine, uric acid),
hematological parameters (thrombocytes,
white globules), coagulation indexes (INR,
Quick time, and APTT), of the inflammat o-
ry process (CRP, fibrinogen) and determi n-
ing the serum concentrations of angiogenic
markers (sFLT -1 and P1GF), by calculating
their ratio (sFlt -1/P1GF) and establishing
the appropriate statistical correlations.
The data were processed and assessed
using the statistic functions from SPSS 19,
at the significance threshold of 95%
(p<0.05). The statistical analysis used the F
(ANOVA) test, 2 test, the Spearman corr e-
lation coefficient, the coefficient of dete r-
mination (R2) and the sFlt -1/PlGF factor.
Considering the clinical picture: HBP
associated to proteinuria and/or edemas 3
study groups were created: PE group – 54
pregnant women (39.13%) with pre –
eclampsia (PE), aged between 19 – 41
years; pregnancy induced hypertension
group (PIH) – 34 pregnant women
(24.63%) with high blood pressure values
and/or insignificant proteinuria (<300
mg/24h) and/or edemas , aged betw een 22
and 44 years; normal pregnant women
group (NG) – 50 pregnant women (36.24%)
aged between 16 and 41 years.
From the 138 pregnant women included
in the study, most of them were in the age
group of 25 -34 years (51.45%), the fr e-
quency peak being somewhe re around the
age of 29 years old. Depending of their
gestational age, in the PE group the p a-
tients were generally in 33 -36 weeks
(37.5%), the patients in the PIH group had

Elena Mihalceanu et al.
476 a homogenous distribution for the gest a-
tional age intervals of 33 -36 weeks and 37 –
40 weeks (29.4%), compared to the witness
group (NG) where the patients were mostly
over 37 weeks (76%).
Edemas were present in 50% of the
pregnant women with PE and in 29.4% of
the ones with PIH, the difference in percent
being significantly higher compare d to the
witness group (p=0.001). Proteinuria was
found in almost 87.5% of the patients in the
PE group and 64.7% in the one with PIH.
Pathological urinalysis was observed in
57.1% of the pregnant women with severe
pre-eclampsia and in 44.7% of the pregnan t
women with milder types of pre -eclampsia,
frequency distributions that were not stati s-
tically significant (p=0.833).
HBP and proteinuria are not invariably
present; HBP may appear late in the evol u-
tion of PE and proteinuria can be absent in
case of milde r types of pre -eclampsia (12).
On the other hand, there have also been
cases of HBP during pregnancy that did not
necessarily lead to pre -eclampsia, as it is
the case of gestational hypertension and
chronic hypertension. For the groups stu d-
ied, the Systoli c blood pressure (SBP) was
significantly higher in the case of pregnant
women with PE (p<0.001), with variations
from 120 to 180 mmHg, the group mean
being of 153.44 ±18.95 mmHg. Most pre g-
nant women in the group with PE recorded
values of systolic blood pre ssure between
143-164 mmHg (37%), but 24% of the
pregnant women with PE recorded values
higher than 160 mmHg. The pregnant
women in the PIH group recorded values of
SBP between 120 -200 mmHg, with a group
mean of 148.65 ±21.03 mmHg. In normal
pregnant women, the systolic blood pre s-
sure varied between 100 -165 mmHg, the
mean value of the group being of
120.40±11.99 mmHg. The diastolic blood pressure (DBP) was significantly higher in
the pregnant women from the group with
PE (p<0.001), with variations from 70 to
150 mmHg, the group mean being of
92.50 ±14.83mmHg. Most pregnant women
from the PE group recorded values of DBP
between 85 -100 mmHg (35%), but 26% of
the pregnant women with PE recorded
values of higher than 120mmHg. The pre g-
nant women from the PIH group recorded
values of DBP between 60 and 120 mmHg,
with a group mean of 88.80 ±14.17 mmHg.
In normal pregnant women, the DBP varied
between 55 and 115 mmHg, the mean value
of the group being of 72.56±11.09 mmHg.
Depending of the growth of DBP, PE was
grouped i n two distinct clinical categories:
mild (<110 mmHg) and severe (>110
mmHg). In the cases studies, it resulted
13% of pregnant women with severe pre –
eclampsia and 87% pregnant women with
mild pre -eclampsia. The severe types of PE
were identified in the pat ients around the
age of 37 years, while the mild types of
pre-eclampsia were associated to the ages
of 28 -29 years (p=0.020).
The mean values obtained for the body
mass index (BMI) indicated significant
over weight (BMI=30.52 kg/m2) in the
patients from th e PE group (p=0.001) and
morbid obesity in 11.8% of the patients in
PIH group compared to the witness group
(NG). Depending of the BMI variation
during pregnancy it was noticed that pre g-
nant women with PE recorded body weight
growth by more than 32%, while the pre g-
nant women with PIH, the BMI growth was
of almost 18%. Gestation and parity did not
point out significant differences between
the monitored groups (p>0.05)
In our study it was noticed that the
women at their first pregnancy, teenagers
and the wome n who remained pregnant
after the age of 40 years presented a higher

The correlation between markers of systemic inflammation and angiogenic markers
in pre -eclampsia
477 risk of being affected by pre -eclampsia.
The values of the biological markers ind i-
cated significantly higher differences for
the PE group compared to the normal group
(NG) for CRP (p=0.00 1), TGO (p=0.001),
uric acid (p=0.001), serum urea (p=0.005)
and proteinuria (p=0.001). In the cases
when the pregnant women developed PE,
the mean value of PlGF was significantly
lower (p=0.003) and sFlt -1 was significan t-
ly higher (p=0.001) compared to th e NG
group. At the same time, the angiogenic
factors were statistically significantly co r-
related with the mean values of BP. Thus,
PlGF was significantly correlated with the
age of the pregnant woman and with high
mean BP (r=0.831; p=0.01). The sFlt -1
factor was significantly correlated with
age, the mean BP and the high levels of
LDH and TGO (r=0.784; p=0.046), being a
better pre -eclampsia predictor than PlGF.
The sFlt -1/ PlGF ratio was significantly
higher at the group of pregnant women with PE (p=0.001) compared to the NG.
The plurality of risk factors: age, mean
blood pressure, LDH, TGO, INR, TQ and
CRP were significantly correlated with the
sFlt-1/ PlGF ratio.
CRP varied from values under 6 up to
192 mg/l recording a mean value signif i-
cantly higher in t he group of pregnant
women with pre -eclampsia compared to the
group of pregnant women with PIH (35.89
vs 6.72 mg/l) (p=0.001)
The individual values of CRP in the
group of pregnant women with PE varied
from 6 to 192 mg/l, most pregnant women
recording val ues in the reliability interval
(RI 95%):26.18 -45.60 mg/l (42.6%), but
14.9% of the pregnant women with PE
recorded values significantly higher of this
parameter. In the case of pregnant women
with PIH, CRP presented some values over
the reference limit (= 6 mg/l), but most of
them presented values < 6 mg/l (82.1)
(tab.1).

TABLE I
The values of some statistical indicators
depending of the severity of pre -eclampsia
STUDY
GROUP N
Mean
Std.
deviation
Std. error Reliability
interval Min Max p
– 95%CI +95%CI
Mean blood pressure (mmHg)
Mild
(moderate) 47 116 7.43 1.55 112.05 119.87 100 137
0.001 Severe 7 155.29 11.18 4.22 144.95 165.62 140 170
Total 54 121.87 16.57 2.25 117.35 126.39 90 170
C-reactive protein (mg/L)
Mild
(moderate) 47 27.45 24.42 5 17.20 37.50 6 96
0.001 Severe 7 89.14 51.31 19.39 41.69 136.60 48 192
Total 54 35.89 35.57 4.84 26.18 45.60 6 192

In the group of pregnant women with PE
the work hypothesis was confirmed, the plasmatic level of CRP is in direct, statist i-
cally significant correlation with the blood

Elena Mihalceanu et al.
478 pressure. The values of CRP were directly
correlated, having statistical significance,
with both SBP (r=0.460; p=0.001) and DBP
(r=0.614; p=0.001) as well as with the mean
calculated pressure (r=0.612; p=0.001)
The mean values of CRP were signif i-
cantly higher in the case of pregnant women
with severe PE (89.14±51.31mg/L) while
the pregnant wo men with mild PE the mean
value was of 22.86±21.35 mg/L. In the cases
studied, the mean values of Hb indicated a
mild anemia in the group of pregnant wo m-
en with PE (p=0.138) without a significant
correlation with its severi ty (p=0.451). The
hematocrit vari ed from 32.7 to 43.5% in the
group of pregnant women with PE, recor d-
ing a mean value of 37.25%±2.63 that is not
significantly higher if compared to the va l-
ues of the h ematocrit recorded in the group
of pregnant women with PIH 36.88% ±3.49
(p=0.102). In the cases of severe PE, the
mean values of the haematocrit were slightly
lower (33.93%±2.92) compared to the ones
recorded in mild cases (34.87%±6.11)
(p=0.847).
It was also observed that the plasmatic
level of CRP was directly correlated also
with the individual values of hemoglobin or
hematocrit, but without any statistical si g-
nificance (13).
In the group of pregnant women with
PE the individual values of PlGF re corded
a variation between 16.37 -942 pg/mL with
a mean value (119.3 pg/mL) significantly
lower if compared to the mean value re c-
orded in the witness group (327.57 pg/mL)
or the PIH group (129.13 pg/mL )
(p=0.003).
It was observed that the patients under
20 years of age had t he PlGF median of
200 pg/mL, and at the patients aged b e-
tween 20 and 34 years the median slightly
surpassed the value of 100 pg/mL; in the pregnant women aged over 35 years the
median of PlGF values was below 100
pg/mL. Depending of the g estational age
the mean value of PlGF was significantly
higher in the gestational weeks 33 -36 (245
pg/mL) and 37 -40 (254.4 pg/mL)
(p=0.049). The correlations between the
individual values of PlGF and the max i-
mum values of blood pressure recorded
were indir ect, of moderate intensity. The
higher values of PlGF were accompanied
by lower values of systolic blood pressure
(r= -0.359; R2=0.1771, p=0.001) or diasto l-
ic (r= -0.320; R2=0.1331, p=0.003). The
correlation between the individual values
of PlGF with BMI w as not statistically
significant (r= -0.126; R2=0.016. p=0.255).
The values obtained for the sFlt -1 factor
varied from 1152 to 32708 pg/mL with a
variation of more than 92%, recording in the
PE group the highest mean value
(14365±6464), significantly highe r if co m-
pared to the other study groups (p=0.001).
Correlated to the age group, the mean values
of sFlt -1 did not indicate statistically signi f-
icant differences (p=0.342); nonetheless
there have been noticed higher mean values
at the age group of over 35 y ears. Depen d-
ing of the gestational age, the mean value of
sFlt-1 was significantly higher in the gest a-
tional weeks 25 -28 (13867 pg/mL) and 29 –
32 (13033 pg/mL) (p=0.001). The correl a-
tions between the individual values of sFlt -1
and the maximum values of blo od pressure
recorded were direct, of moderate intensity,
and statistically significant. The higher va l-
ues of sFlt -1 were accompanied by high
values of systolic blood pressure (r= +0.397;
R2=0.3445, p=0.001) or diastolic (r=
+0.430; R2=0.2755, p=0.001). The re were
not any significant correlations between the
individual values of sFlt -1 and BMI (r= –
0.136; R2=0.0184, p=0.222) (Fig.1).

The correlation between markers of systemic inflammation and angiogenic markers
in pre -eclampsia
479

Fig 1 . Mean values of PlGF, sFlt -1 and the sFlt -1/ PlGF ratio on study groups

Elena Mihalceanu et al.
480
The values of the sFlt -1/PlGF ratio i n-
dicated significant growth for the PE group
compared to the witness group NG or PIH
(p=0.001). In the patients with pre –
eclampsia, it was observed a direct correl a-
tion, of moderate intens ity, between the
systolic blood pressure (SBP) and sFlt –
1/PlGF (r= +0.555; p=0.026), but the high
values of diastolic blood pressure (DBP)
are associated with high values of sFlt –
1/PlGF only in 18.5% of the patients
(r=+0.185; p=0.493). At the patients fro m
the PIH group, the correlation between SBP
(r=+0.014; p=0.937) and DBP (r=+0.105; p=0.555) and the sFlt -1/PlGF ratio were
not statistically significant.
The high values of CRP were accomp a-
nied by high values of sFlt -1/PlGF ratio
only in 13.8% of the pati ents with PE (r=
+0.138; p=0.724) and in 48% of the p a-
tients with PIH (r=+0.480; p=0.015). Co r-
relating the values of PlGF with the pre –
eclampsia risk factors it was noticed that
the logistic model indicated an important
cumulative risk depending of the age of the
pregnant woman and the presence of high
mean blood pressure (p=0.01 – Model 2)
(fig. 2).

Fig. 2. PlGF correlation with age and mean blood pressure

It was noticed that PE was characterized
by high levels of sFlt -1 associated with
HBP, proteinuria and high values of CRP
(p=0.049 – Model 8).
Correlating the values of sFlt -1 with the
risk factors for PE it was noticed that the
logistic model indicated an important c u-
mulative risk depending of the age of the
pregnant woman, the presence of high
mean blood pressure and high LDH values
(p=0.047 – Model 3) and the pregnant
woman’s age, the presence of high mean
blood pressure and high LDH and TGO values (p=0.046 – Model 4) (fig. 3).
The logistic model indicated that a
group of risk factors as age, blood pressure,
LDH, TGO, INR, TQ and CRP were signi f-
icantly correlated with the sFlt -1/PlGF ratio
(R=0.663; p=0.04).
Nowadays there isn’t any single obje c-
tive test to identify PE or to quan tifying the
risk of certain severe complications, the
diagnosis relying only on the clinical lab
parameters evaluated in dynamics. Exper i-
ence shows that early identification and the
monitoring of the mother and fetus are us e-

The correlation between markers of systemic inflammation and angiogenic markers
in pre -eclampsia
481 ful and hence the prediction of PE becomes
very important. Early identification of PE,
not only based on the inventory of risk fa c-
tors, but also with the use of some markers
might indicate better the moment suitable
for beginning the treatment, its action and the moment to remove the chi ld. Because of
the fact that these modifications appear a
long time before the apparition of the clin i-
cal signs of the disease, recent research
focus on the endothelial dysfunction as a
physiopathological mechanism of PE.

Fig. 3 . sFlt -1 correlation with age and mean blood pressure

Many researchers (14, 15) noticed that
the inflammatory maternal answer in PE
and especially in severe PE, being known
that there is an exaggerated systemic m a-
ternal inflammatory answer (16). In this
context, it is considered that PE, at a given
moment in its evolution, borrows a link of
the systemic inflammatory answer that
combines with the endothelial dysfunction.
The increase of CRP indicates the presence
of an inflammatory, destructive, infectious
or non -infectious process but not specific.
In this study we have demonstrated that the
plasmatic level of CRP is significantly and
directly correlated with SBP and DBP.
Thus, Can (17) use the mean arterial
pressure as a severity indicator and he
demonstrated the direct association with
the inflammatory reaction. This result joins the studies that support the affirmation that
CRP is an effective marker for the appar i-
tion of PE and it correlates significantly
with the se verity of the disorder.
Carl et al. (18) demonstrated that a va l-
ue of more than 3 mg/L is a good predictor
for cardiovascular and inflammatory risk in
women with pre -eclampsia / eclampsia
antecedents. At the same time, Mihu D et
al. (10), state that CRP i s a marker for PE’s
severity and for the new -born’s birth
weight. A prospective study, initiated by
Behboudi et al. (20) on a group of 778
pregnant women, established a reference
value of 4.5 mg/dL for CRP in the first
trimester of pregnancy as a predictiv e fac-
tor for PE, and Bita (12) with a study on
400 pregnant women established the
threshold over which PE can be predicted,

Elena Mihalceanu et al.
482 in the first trimester of pregnancy of more
than 5 mg/L. In order to establish reference
values for CRP in normal pregnant women
and pregnant women with PE, Hwang et al.
(19) demonstrated also the possibility of
using CRP as a severity marker in PE.
Other authors pointed out the relatio n-
ship between CRP and the clinical and
biochemical parameters from PE; the high
levels of hemoglobin , creatinine, TGO,
TGP, LDH, blood urea and proteinuria
were associated with high levels of CRP.
Nowadays, more and more studies co n-
firm the fact that the CRP (10) marker can
help in differentiating the pregnancy ass o-
ciated HBP whose etiology is not PE. O ther
studies, on the other hand, could not esta b-
lish a real relationship between CRP and
PE (13). In recent studies, Stefanovic (21)
focused on the endothelial dysfunction as
an anomaly in PE and concluded that CRP
as a marker of the inflammation does not
have high values and it is not associated
with the severity of PE.
The high CRP values are a useful para m-
eter in assessing the severity risk of PE in
pregnant women with high body mass index
in the third trimester of pregnancy (13). In
our case it was noti ced a risk of 6.71 times
higher of severe PE in obese patients.
Considering the importance of carefully
monitoring the mother and the fetus and the
therapeutic intervention at the best moment
in the process of PE, to avoid fontal and
maternal complications , in this study it was
assessed the sensitivity and the specificity of
some laboratory tests, including the usual
ones, that focus on assessing various angi o-
genesis markers in pre -eclampsia diagnosis
and management. PlGF and sFlt -1/PlGF
ratio were correlat ed with the clinical and
laboratory signs of the cases included in the
study. The higher the sFlt -1/PlGF ratio the better can it assess the risk of premature
birth and it represents a potential prognosis
parameter in PE monitoring.
It was noticed that PlGF and sFlt -1 lev-
els are simultaneously affected in PE (e s-
pecially in early pre -eclampsia); thus, the
sFlt-1/PlGF ratio represents now a predi c-
tor element superior to the individual ana l-
ysis of these markers. Another approach in
assessing these markers might consist in
the sequential determination of serum le v-
els, an approach that has provided better
predictive results than the punctual asses s-
ment in of the pregnancy a certain moment.
The sensitivity of sequential determinations
of the sFlt -1/PlGF ratio is of 100% and its
specificity is of 98 -99% (3, 5).
It was noticed that sFlt -1 levels and
sFlt-1/PlGF ratio increase while PlGF le v-
els decrease significantly in patients who
develop PE, all this compared to the levels
measured in normal pregnancies or in p a-
tients with chronic kidney disease (CKD).
sFlt-1 levels increase and PlGF levels d e-
crease even more in women who simult a-
neously associate CKD or chronic hype r-
tension during pregnancy.

CONCLUSIONS
In our study it resulted that the mean
value for the CRP marke r correlated with
SBP, DBP and mean BP, but it did not co r-
relate with hemoglobin and h ematocrit.
It was pointed out that CRP is an i n-
flammation marker but in PE it was not
proved that it can be used in the clinical
practice on a daily basis.
The results of our study confirm the i m-
portance of establishing sFlt -1 and PlGF as
markers for the diagnosis and the monito r-
ing of pregnant women with HBP as well
as the sFlt -1/ PlGF ratio which represents a
good PE predictor.

The correlation between markers of systemic inflammation and angiogenic markers
in pre -eclampsia
483
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