The Utility of 12-Hour Urine Collection for the Diagnosis of Preeclampsia

Stout, Molly J.; Colditz, Graham A.; Macones, George A.; Tuuli, Methodius G.

doi:10.1097/aog.0000000000001042

Cited by 11 publications

(12 citation statements)

References 18 publications

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“…This cut-off is associated with 99% specificity and 92% sensitivity for the diagnosis of pre-eclampsia. The use of the 12-hour urine collection would be more convenient, expedite diagnosis and clinical management, and decrease cost 33 . The results are awaited of the “diagnostic accuracy in pre-eclampsia using proteinuria assessment” (DAPPA) study, aimed at comparing the diagnostic accuracy of different methods of assessing proteinuria at various thresholds in predicting severe pre-eclampsia compared with 24-hour urine protein measurement 34 .…”

Section: New Developments In Predictionmentioning

confidence: 99%

Recent advances in the diagnosis and management of pre-eclampsia

2018

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Pre-eclampsia is a leading cause of maternal mortality, responsible annually for over 60,000 maternal deaths around the globe. Pre-eclampsia is a multisystem disease featuring hypertension, proteinuria, and renal, hepatic, and neurological involvement. Diagnosis is often elusive, as clinical presentation is highly variable. Even those with severe disease can remain asymptomatic. Angiogenic factors are emerging as having a role in the diagnosis of pre-eclampsia and in prognostication of established disease. In this article, we summarize new developments and focus on angiogenic biomarkers for prediction of disease onset. We also discuss recent advances in management strategies for patients with hypertensive disorders of pregnancy.

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Section: New Developments In Predictionmentioning

confidence: 99%

Recent advances in the diagnosis and management of pre-eclampsia

2018

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“…The present study design followed the suggestions of Stout et al . by obtaining a large sample size, ensuring that the collection of urine was homogeneous, and stratifying the samples by diurnal versus nocturnal.…”

Section: Discussionmentioning

confidence: 99%

“…A systematic review and meta‐analysis by Stout et al . found that 12‐hour urine collection, with a 150 mg cut‐off level for proteinuria, performed well among women with hypertension during pregnancy.…”

Section: Introductionmentioning

confidence: 99%

“…2,3 The protein-to-creatinine ratio test is undoubtedly more practical and convenient to perform than the 24-hour urine collection test but some controversy remains given the wide range of sensitivity (65%-96%), specificity (49%-100%), and clinical heterogeneity reported. [4][5][6] A systematic review and meta-analysis by Stout et al 7 found that 12-hour urine collection, with a 150 mg cut-off level for proteinuria, performed well among women with hypertension during pregnancy.…”

Section: Introductionmentioning

confidence: 99%

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Accuracy of 12‐hour urine collection in the diagnosis of pre‐eclampsia

Silva

Pereira

Rego

et al. 2018

Intl J Gynecology & Obste

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Objective: To evaluate the accuracy of a 12-hour urine collection to diagnose preeclampsia and to determine whether time of collection influences the performance of this test.Methods: A prospective observational study was conducted in a tertiary obstetric center in Portugal between November 1, 2015, and November 30, 2016. Pregnant women (≥20 weeks) admitted for observation with suspected pre-eclampsia were eligible for inclusion. Two consecutive 12-hour urine samples were collected (07:00-19:00 hours vs 19:00-07:00 hours). Protein levels were measured in each 12-hour sample, as well as in a pooled sample (07:00-07:00 hours). The diagnostic cut-off values for pre-eclampsia were 150 mg (12-hour samples) and 300 mg (24-hour sample). Results:The study included 99 patients and diagnoses of pre-eclampsia were confirmed among 42 (42%) patients. In all, 456 12-hour urine samples were analyzed (equivalent to 228 24-hour samples). Qualitative analysis (pre-eclampsia vs no preeclampsia) indicated substantial agreement between the 12-and 24-hour samples (Cohen κ 0.779). The sensitivity was 85.9% (95% confidence interval [CI] 81%-90%) and the specificity was 91.7% (95% CI 88%-95%). No statistically significant difference was found between the two 12-hour collections. Conclusion:The 12-hour test showed acceptable accuracy for detecting pre-eclampsia, regardless of the time of collection. K E Y W O R D S24-hour urine collection; Hypertensive disorders of pregnancy; Non-inferiority; Pre-eclampsia; Proteinuria | INTRODUCTIONPre-eclampsia and other hypertensive disorders of pregnancy account for 10.3%-22.1% of all maternal deaths worldwide.1 The current diagnostic criteria indicate that proteinuria should no longer be considered an obligatory component of pre-eclampsia 2,3 ; however, quantification of urinary protein levels is still routine practice.A 24-hour urine collection, with a 300 mg cut-off level for proteinuria, remains the gold standard to diagnose the presence of substantial proteinuria. Nonetheless, alternative methods-including the urine spot protein-to-creatinine ratio with a cut-off of 0.3-are considered equivalent by many obstetric societies. 2,3 The protein-to-creatinine ratio test is undoubtedly more practical and convenient to perform than the 24-hour urine collection test but some controversy remains given the wide range of sensitivity (65%-96%), specificity (49%-100%), and clinical heterogeneity reported. 4-6A systematic review and meta-analysis by Stout et al. 7 found that 12-hour urine collection, with a 150 mg cut-off level for proteinuria, performed well among women with hypertension during pregnancy.However, the main limitations were the small sample sizes of the studies included in the analysis, the heterogeneous methods used for urine collection, and the lack of information on time of collection.

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“…This research quality assessment method follows a typical evidence-based procedure whereby experts are gathered, probe questions from a pool are chosen for a given diagnostic or screening question/tool, the questions' utility is field tested, and reliability of ratings is established. The QUADAS and QUADAS-2 are very widely used for both diagnostic and screening tests in both the behavioral [52–54] and medical [55–57] fields. This rating system was not applied formally (i.e., assigning numerical ratings) but instead adapted in the following way: (1) the four domains of Participants, Index Test (the screening tool), the Reference Standard (the “gold standard”), and Timing and Flow were used as units of review with the additional domains of Evaluation and Performance; (2) probe questions were developed for each of the domains; and (3) the probe questions were applied to each study and conclusions were summarized.…”

Section: Methodsmentioning

confidence: 99%

Autism Spectrum Disorder Screening Instruments for Very Young Children: A Systematic Review

Towle

Patrick

2016

Autism Research and Treatment

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Research on ASD in infancy has provided a rationale for developing screening instruments for children from the first year of life to age of 18 months. A comprehensive literature search identified candidate screening tools. Using methodological probe questions adapted from the Quality Assessment of Diagnostic Accuracy Studies (QUADAS), two Level 1 and three Level 2 screening instruments were reviewed in detail. Research evidence conclusions were that instrument development was in beginning phases, is not yet strong, and requires further development. Clinical recommendations were to continue vigilant developmental and autism surveillance from the first year on but to use the screening instruments per se only for high-risk children rather than for population screening, with considerations regarding feasibility for individual settings, informing caregivers about strengths and weaknesses of the tool, and monitoring new research.

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The Utility of 12-Hour Urine Collection for the Diagnosis of Preeclampsia

Abstract: A 12-hour urine collection compares favorably with a 24-hour urine collection for the diagnosis of proteinuria in women with suspected preeclampsia and has the advantage of convenience and improved clinical efficiency.

Cited by 11 publications

References 18 publications

Recent advances in the diagnosis and management of pre-eclampsia

Recent advances in the diagnosis and management of pre-eclampsia

Accuracy of 12‐hour urine collection in the diagnosis of pre‐eclampsia

Autism Spectrum Disorder Screening Instruments for Very Young Children: A Systematic Review

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