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Abstract
Objective To investigate the correlation between serum placental protein 13 (PP13), D-dimer
(D-D), neurofilament light chain protein (NfL) and the risk of adverse pregnancy outcomes in patients with
preeclampsia (PE) and their combined predictive efficacy. Methods A prospective study was conducted, 300
patients with PE who were treated in the Second People's Hospital of Hengshui from May 2020 to May 2023
were selected. All patients were followed up until delivery. According to the pregnancy outcome, they were
divided into good outcome group (n=56) and poor outcome group (n=244). The clinical data and serum levels
of PP13, D-D and NfL were compared between the two groups. The serum levels of PP13, D-D and NfL
were compared between 183 patients with PE and 117 patients with severe preeclampsia (SPE). Multivariate
Logistic regression analysis was used to explore the effects of serum PP13, D-D and NfL levels on pregnancy
outcomes. Spearman correlation coefficient model was used to analyze their correlation. Receiver operating
characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the efficacy of serum
PP13, D-D and NfL alone and combination in predicting the risk of adverse pregnancy outcomes in patients
with PE. Statistical analysis was performed using the independent samples t-test and χ 2 test. Results The
proportion of SPE, 24-hour urinary protein quantification (24 hUP), systolic blood pressure and diastolic
blood pressure in the poor outcome group were higher than those in the good outcome group [55.36%
(31/56) vs 35.25% (86/244), (3.58±1.04) g vs (2.40±0.73) g, (152.67±10.15) mmHg vs (138.92±8.27)
mmHg (1 mmHg=0.133 kPa), (100.38±8.52) mmHg vs (93.16±6.39) mmHg, χ 2value was 7.744, t values
were 10.000, 10.731, 7.131, all P<0.05]. The serum PP13 level in the poor outcome group was lower than
that in the good outcome group [(42.33±10.31) ng/L vs (54.12±15.28) ng/L, t value was 5.491, P<0.001].
The levels of D-D and NfL in the poor outcome group were higher than those in the good outcome group
[(1.05±0.31) mg/L vs (0.82±0.18) mg/L, (6.41±1.83) ng/L vs (4.83±1.15) ng/L, t value was 7.387,
8.187, all P<0.001]. The serum PP13 level in SPE patients was lower than that in PE patients [(44.85±9.64) ng/
L vs (56.44±14.02) ng/L, t value was 7.834, P<0.001]. The serum D-D and NfL levels in SPE patients were
higher than those in PE patients [(1.01±0.26) mg/L vs (0.76±0.17) mg/L, (5.83±1.11) ng/L vs (4.67±1.04)
ng/L, t values were 10.073, 9.178, all P<0.001]. Serum PP13 level was negatively correlated with the severity
of PE, while D-D and NfL levels were positively correlated with the severity of PE (all P<0.001). Before and
after correction of other factors such as severity of disease, 24 hUP, systolic blood pressure and diastolic blood
pressure, serum PP13, D-D and NfL were independent influencing factors of pregnancy outcome in patients
with PE (all P<0.001). The AUC of combined serum PP13, D-D and NfL in predicting the risk of adverse
pregnancy outcomes in patients with PE was 0.931 (95% CI: 0.896-0.957), the sensitivity was 85.71%, and
the specificity was 88.52%. Conclusion The serum levels of PP13, D-D and NfL are significantly correlated
with the severity of PE and exert independent effects on the risk of adverse pregnancy outcomes, which can be
used as independent predictive factors. Combined detection of the three indicators can significantly improve
the predictive efficacy for adverse pregnancy outcomes, demonstrating important clinical application value.
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2026, Vol. 14 
