Figure 2: The area under the ROC curves for the single and a combination of biomarkers of OS and AGMs measured at 10-20 weeks gestation (W1) and 21-31 weeks gestation (W2) for the prediction of PE (all cases).
The best predictive marker for SHS pregnant women likely to develop EO-PE was the mid-pregnancy 8-OHdG/PIGF ratio with a significantly high discriminating power or AUC (0.97, p <0.0001)(Figure 3c), sensitivity (96.4%), specificity (81.1%), NPV (75.5%) and PPV (97.5%), at a cut-off value ≥0.8. At this cut-off value, SHS-PW were at 6.5-fold increased odds of developing EO-PE [aOR =6.5, 95%CI (1.4-12.5), p <0.001] (Table S2) .
Similarly, the mid-pregnancy (W2) 8-OHdG/PIGF ratio and sFlt-1/PlGF ratio yielded the best and same AUC (0.93, p <0.001) for predicting SHS pregnant women likely to develop LO-PE (Figure 3f) . A cut-off value ≥0.8 for the 8-OHdG/PIGF ratio yielded a sensitivity and specificity (97.8% and 92.7%, respectively), PPV (92.4%), NPV (78.7%) and 4.5-fold increased odds (aOR =4.5 95%CI (1.5-10.2), p <0.001) of SHS pregnant women developing LO-PE (Table S3).
Except for W1 TAC levels, all the single and combined biomarkers of OS and AGMs yielded a significant (all p <0.05) discriminating power and adjusted odds ratios for predicting SHS pregnant women likely to develop EO-PE and LO-PE, however, the combined biomarkers yielded a highest predictive accuracy (Tables S2 and 3) .