Blood urea nitrogen/creatinine index is a predictor of prerenal damage in preeclampsia

Hu²,

Clinical Laboratory Analysis

et al. 2021

Background Preeclampsia (PE) prediction has been shown to improve the maternal and fetal outcomes in pregnancy. We aimed to evaluate the PE prediction values of a series of serum biomarkers. Methods The singleton pregnant women (20–36 gestational weeks) with PE‐related clinical and/or laboratory presentations were recruited and had the blood drawn at their first visits. The following markers were tested with the collected serum samples: soluble fms‐like tyrosine kinase 1 (sFlt‐1), placental growth factor (PlGF), thrombomodulin (TM), tissue plasminogen activator inhibitor complex (tPAI‐C), complement factors C1q, B, H, glycosylated fibronectin (GlyFn), pregnancy‐associated plasma protein‐A2 (PAPP‐A2), blood urea nitrogen (BUN), creatinine (Cre), uric acid (UA), and cystatin C (Cysc). Results Of the 196 recruited subjects, 25% (n = 49) developed preeclampsia before delivery, and 75% remained preeclampsia negative (n = 147). The serum levels of sFlt‐1, BUN, Cre, UA, Cysc, and PAPP‐A2 were significantly elevated, and the PlGF level was significantly decreased in the preeclampsia‐positive patients. In the receiver operating characteristics (ROC) analyses, the area under the curves were listed in the order of decreasing values: 0.73 (UA), 0.67 (sFlt‐1/PlGF), 0.66 (Cysc), 0.65 (GlyFn/PlGF), 0.64 (PAPP‐A2/PlGF), 0.63 (BUN), 0.63 (Cre), and 0.60 (PAPP‐A2). The positive predictive values of these serum markers were between 33.1% and 58.5%, and the negative predictive values were between 80.9% and 89.5%. Conclusions The serum markers investigated in current study showed better performance in ruling out than ruling in PE. Absence of pre‐defined latency period between blood draw and the onset of PE limits the clinical utility of these markers.

Section: Discussionmentioning

confidence: 86%

Predictive values of various serum biomarkers in women with suspected preeclampsia: A prospective study

Hu²,

Clinical Laboratory Analysis

et al. 2021

“…However, the common renal function tests such as BUN, Cre, UA and Cysc were shown to be potential valuable markers for PE diagnosis and/or prediction. For example, the BUN (29) and BUN/Cre ratio (30) were both found increased in the PE patient compared with normal controls. Cysc, the alternative test of Cre used in glomerular ltration rate estimation, was found elevated in PE patients (31) and was able to predict PE in combination of neutrophil gelatinase-associated lipocalin (AUC = 0.88) (32).…”

Section: Discussionmentioning

confidence: 86%

Predictive values of multiple serum biomarkers in women with suspected preeclampsia: a prospective study

Hu²,

et al. 2020

Preprint

Background Early preeclampsia (PE) prediction has been shown to improve the maternal and fetal outcomes in pregnancy. We aimed to evaluate the PE prediction values of a series of serum biomarkers. Methods The singleton pregnant women with PE-related clinical and/or laboratory presentations were recruited and had the blood drawn at their first visits. The prospective cohort was further divided into the PE-positive and PE-negative groups based on the follow-up results. The following markers were tested with the collected serum samples: sFlt-1, PlGF, M, tPAI-C, compliment factors C1q, B, H, BUN, GlyFn, PAPP-A2, BUN, Cre, UA and Cysc. Results Totally 196 women suspected for PE were recruited with follow-up medical records. Twenty-five percent of the recruited subjects developed PE before delivery and 75% remained PE-negative. The serum levels of sFlt-1, BUN, Cre, UA, Cysc and PAPP-A2 were significantly elevated and the PlGF was significantly decreased in the PE-positive patients. The AUCs were listed in the order of decreasing values: UA (AUC = 0.73), sFlt-1/PlGF (AUC = 0.67), Cysc (AUC = 0.66), GlyFn/PlGF (AUC = 0.65), PlGF (AUC = 0.64), PAPP-A2/PlGF (AUC = 0.64), sFlt-1 (AUC = 0.63), BUN (AUC = 0.63), Cre (AUC = 0.63), and PAPP-A2 (AUC = 0.60) in the ROC analyses. The Logistic regression analysis showed that UA and PAPP-A2 were independent risk factors for PE development with the odds ratios of 3.3 and 2.2 respectively. Moreover, the PPVs of UA and PAPP-A2 were 48.9%, and 40.4%; the NPVs of UA and PAPP-A2 were 82.1% and 81.9%. Conclusions Further studies are warranted to confirm the clinical utilities of the serum markers in PE prediction.

“…Conversely, the common renal function tests such as BUN, Cre, UA and Cysc were shown to be potentially valuable in preeclampsia diagnosis and prediction. For example, the BUN (27) and BUN/Cre ratio (28) were both found increased in the preeclampsia patients compared with normal controls. Cysc, the alternative test of Cre used in glomerular ltration rate estimation, was found to be elevated in preeclampsia patients (29) and was able to predict preeclampsia in combination with neutrophil gelatinase-associated lipocalin (AUC=0.88) (30).…”

Section: Discussionmentioning

confidence: 89%

Predictive values of multiple serum biomarkers in women with suspected preeclampsia: a prospective study

Hu²,

et al. 2020

Preprint

Background: Preeclampsia is a common obstetric multisystem disorder causing maternal and fetal morbidity and mortality; it’s been shown that the prediction improves preeclampsia outcomes in pregnancy. However, the current serum biomarkers had low clinical application values and still lack validation studies. Here we aimed to evaluate the preeclampsia prediction values of a series of serum biomarkers in Chinese pregnant women of > 20 weeks of gestation. Methods: Singleton pregnant women with preeclampsia-related clinical and/or laboratory presentations were recruited and had blood drawn at their first visits. The prospective cohort was further divided into preeclampsia-positive and preeclampsia-negative groups based on the follow-up results. The following markers were tested using the collected serum samples: soluble fms-like tyrosine kinase-1 (sFlt-1); placental growth factor (PlGF); thrombomodulin (TM); tissue plasminogen activator inhibitor complex (tPAI-C); compliment factors C1q, B, and H; glycosylated fibronectin (GlyFn); pregnancy-associated plasma protein-A2 (PAPP-A2); blood urea nitrogen (BUN); creatinine (Cre); uric acid (UA); and cystatin C (Cysc). Results: A total of 196 women with suspected preeclampsia were recruited with follow-up medical records. Twenty-five percent (n=49) of the recruited subjects developed preeclampsia before delivery, and 75% remained preeclampsia-negative (n=147). The serum levels of sFlt-1, BUN, Cre, UA, Cysc and PAPP-A2 were significantly elevated, and the PlGF level was significantly decreased in the preeclampsia-positive patients. In the receiver operating characteristics (ROC) analyses, the area under the curves were listed in the order of decreasing values: 0.73 (UA), 0.67 (sFlt-1/PlGF), 0.66 (Cysc), 0.65 (GlyFn/PlGF), 0.64 (PAPP-A2/PlGF), 0.63 (BUN), 0.63 (Cre), and 0.60 (PAPP-A2). With the cut-off values obtained from the ROC analyses, the positive predictive values of these serum markers were between 33.1% and 58.5%, and the negative predictive values were between 80.9% and 89.5%. Conclusions: Although several serum markers were found to be significantly changed with current prospective cohort, their limited predictive values in preeclampsia development posed potential barrier in clinical implementation. Further studies with larger cohort are warranted to further reveal the clinical utilities of the serum markers in preeclampsia prediction.