Evaluation of spot urinary protein-creatinine ratio as a predictor of preeclampsia

Abstract

Background and Objectives: Hypertensive disorders are the most common medical complications of pregnancy with an incidence of 12-22% and are rampant globally. The aim of the study was to establish whether a spot urinary protein -creatinine ratio (UPCR) measured between 20-24 weeks of gestation can predict subsequent development of preeclampsia Methods: The prospective observational study included 120 pregnant mothers with singleton pregnancy with normal renal function having no proteinuria, attending antenatal clinics between 20-24 weeks of gestational age in two tertiary care teaching hospitals. Spot UPCR test was done in a mid-stream urine sample and protein was estimated by immunoturbidimetric microalbumin method and creatinine by modified Jaffe's method. Data was expressed as urine protein (mg/dl)/ urine creatinine (g/dl) = UPCR in mg/g or mg/mmol multiplying by 0.113. Results: Prevalence of preeclampsia was 12.93%. The mean UPCR (mg//mmol) in unaffected group and preeclampsia groups was 26.84±4.69 and 44.12± 9.43 respectively. The optimal cut-off value of spot UPCR was considered 35.5 mg/mmol. The relative risk (RR) of developing preeclampsia in women with UPCR ≥35.5 mg/mmol was 21.78 (95% CI, 6.82-69.54, p=0.0001). The sensitivity, specificity, PPV and NPV are of 80% and 94.06%, 66.67% and 96.94% respectively at or above UPCR cut-off value of 35.5 mg/mmol. The area under curve (AUC) of spot UPCR in ROC curve was 0.949 (95% CI, 0.891-1.000). Conclusions: A Spot UPCR ≥ 35.5 mg/mmol in the early part of mid trimester with high sensitivity and specificity is an accurate, reliable and steady fast time saving test that can predict the development of preeclampsia in later part of pregnancy.

Accuracy of Spot Urine Albumin Creatinine Ratio With Respect to 24-Hour Urine Albumin for the Detection of Proteinuria in Antenatal Women With Preeclampsia: A Descriptive Study

“…In the present study, 74 (75.5%) were found to be positive (+3) by urinary dipstick grading which is similar to a study given by Mahesh et al that reported 53 patients positive with urinary dipstick grading [ 18 ] whereas contrast with the above-mentioned studies Amin et al reported a very less number of positive (+3) patients 10 (9.8%) [ 23 ]. In the present study, the sensitivity of 85.71%, and specificity of 95.24% validates the spot UACR in the prediction of significant proteinuria which is similar to a study given by Mahesh et al and Modak et al that demonstrated sensitivity of 95% and 80%, respectively, and specificity of 80% and 94.06%, respectively [ 18 , 19 ]. In contrast with the above-mentioned studies, the study given by Amin et al reported high sensitivity of 89.7% with low specificity of 54.2% [ 23 ].…”

“…In the present study, the mean SBP was found to be 150.12±8.95 and the mean DBP was found to be 101.20±6.12, which corresponds with a study given by Amin et al and Mahesh et al that demonstrated mean SBP of 152±18.2 range between 132-178 and 155.26±10.08, respectively, and mean DBP of 96.4±11.3 ranging between 78-116 and 102.11±7.04, respectively [ 18 , 23 ]. In contrast with the above study given by Modak et al, the mean SBP and DBP were 117.6 and 72.4, respectively [ 19 ]. In this study, the maximum number of patients were in the non-severe PE group 59 (60.2%) and the rest were in the severe PE 39 (39.8%).…”

“…In the present study, the number of patients that were nullipara involved 33 (33.6%), para gravida 1 involved 25 (25.5%), para gravida 2 consisted of 24 (24.48%), followed by para 3 including 11 (11.2%), and more than or equal to para 4 involving five (5.1%). In a similar study by Modak et al in 2019, the maximum number of patients involved was primigravida which consisted of eight (53.33%) patients, followed by para 2 which involved four (26.67%) patients, and para 3 which involved three (20%) patients [ 19 ].…”

“…Numerous researchers have looked into the clinical importance of spot UACR during pregnancy. Some studies have shown accuracy when compared with 24-h UA [17][18][19][20] while some studies have shown that spot UACR is not as accurate as 24-h UA [21,22], and yet there is no consensus opinion. Currently, spot UACR is not used as a routine test to evaluate proteinuria in women with hypertensive disorders.…”

Microalbuminuria and spot protein creatinine ratio in early pregnancy as a predictor of preeclampsia

“…[11][12][13] There are studies that show strong association between random protein-creatinine ratio and 24 hour urinary protein excretion, the international society for the study of hypertension in pregnancy has accepted this test as a method for identifying significant proteinuria. 14 This suggests that microalbuminuria and elevated spot protein creatinine ratio in early pregnancy could predict preeclampsia.…”