European journal of obstetrics, gynecology, and reproductive biology · 2026
Clinical significance and diagnostic performance of maternal circulating soluble ST2 in preeclampsia: A systematic review and meta-analysis.
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Simanjuntak Artha Maressa Theodora, Wirya Wendy, Arta Komang Indra Parama, Wijayanto Frengki Prabowo Saputro
Аннотация
BACKGROUND: Soluble suppression of tumorigenicity-2 (sST2) has emerged as a promising inflammatory biomarker implicated in the pathophysiology of preeclampsia (PE). This systematic review and meta-analysis evaluated maternal circulating sST2 concentrations according to the timing of sampling, and its diagnostic accuracy for PE.
METHODS: PubMed, Scopus, Epistemonikos, and EBSCOhost were searched from inception to September 20, 2026, supplemented by Google Scholar and citation searching, without language restrictions. Observational studies comparing maternal circulating sST2 between women with PE and normotensive pregnant controls were included. Mean differences (MDs) were pooled using random-effects models, separately for antepartum samples obtained at or after clinical diagnosis and for trimester-specific samples obtained before clinical onset, with subgroup, meta-regression and (when I2 > 50%) sensitivity analyses. Diagnostic accuracy was synthesized using generalized linear mixed and bivariate models. Risk of bias was assessed using ROBINS-E and, for diagnostic accuracy studies, QUADAS-2.
RESULTS: Eight studies (430 women with PE, 606 controls) were included. In samples obtained at or after clinical diagnosis, sST2 was higher in PE (MD 45.78 ng/mL, 95% CI 14.63-76.93, I2 = 97.1%), consistently across leave-one-out analyses and on standardized (1.35, 0.87-1.83) and ratio-of-means (2.18, 1.68-2.86) scales. Before clinical onset, no first-trimester difference was observed (MD -0.34, -7.23-6.55), and second- and early-third-trimester differences were small and imprecise. Egger's test suggested small-study effects (p < 0.001), and trim-and-fill attenuated the estimate (MD 6.17, -38.23 to 50.57). In three heterogeneous studies (426 women) with different sampling times and thresholds, exploratory summary sensitivity and specificity were 0.76 (0.51-0.90) and 0.80 (0.52-0.94). In the two studies sampling at diagnosis, they were 0.71 (0.42-0.90) and 0.84 (0.63-0.94).
CONCLUSIONS: Maternal circulating sST2 is elevated in established PE, but evidence of elevation before clinical onset is limited and diagnostic accuracy is uncertain. sST2 cannot currently be recommended for the prediction or diagnosis of PE, and prospective studies with standardized assays, gestational-age-specific thresholds and evaluation of incremental value over the sFlt-1/PlGF ratio are required.
METHODS: PubMed, Scopus, Epistemonikos, and EBSCOhost were searched from inception to September 20, 2026, supplemented by Google Scholar and citation searching, without language restrictions. Observational studies comparing maternal circulating sST2 between women with PE and normotensive pregnant controls were included. Mean differences (MDs) were pooled using random-effects models, separately for antepartum samples obtained at or after clinical diagnosis and for trimester-specific samples obtained before clinical onset, with subgroup, meta-regression and (when I2 > 50%) sensitivity analyses. Diagnostic accuracy was synthesized using generalized linear mixed and bivariate models. Risk of bias was assessed using ROBINS-E and, for diagnostic accuracy studies, QUADAS-2.
RESULTS: Eight studies (430 women with PE, 606 controls) were included. In samples obtained at or after clinical diagnosis, sST2 was higher in PE (MD 45.78 ng/mL, 95% CI 14.63-76.93, I2 = 97.1%), consistently across leave-one-out analyses and on standardized (1.35, 0.87-1.83) and ratio-of-means (2.18, 1.68-2.86) scales. Before clinical onset, no first-trimester difference was observed (MD -0.34, -7.23-6.55), and second- and early-third-trimester differences were small and imprecise. Egger's test suggested small-study effects (p < 0.001), and trim-and-fill attenuated the estimate (MD 6.17, -38.23 to 50.57). In three heterogeneous studies (426 women) with different sampling times and thresholds, exploratory summary sensitivity and specificity were 0.76 (0.51-0.90) and 0.80 (0.52-0.94). In the two studies sampling at diagnosis, they were 0.71 (0.42-0.90) and 0.84 (0.63-0.94).
CONCLUSIONS: Maternal circulating sST2 is elevated in established PE, but evidence of elevation before clinical onset is limited and diagnostic accuracy is uncertain. sST2 cannot currently be recommended for the prediction or diagnosis of PE, and prospective studies with standardized assays, gestational-age-specific thresholds and evaluation of incremental value over the sFlt-1/PlGF ratio are required.