A prospective comparison of total protein/creatinine ratio versus 24-hour urine protein in women with suspected preeclampsia - 28/08/11
Abstract |
Objective |
The purpose of this study was to determine the value of the protein/creatinine ratio in prediction of 24-hour urine total protein among women with suspected preeclampsia.
Study design |
Women who were evaluated for suspected preeclampsia at ≥24 weeks of gestation were studied prospectively if there was no concurrent diagnosis of chronic hypertension, diabetes mellitus, or preexisting renal disease. A protein/creatinine ratio was obtained, which was followed by the initiation of a 24-hour urine evaluation. Positive and negative predictive values and sensitivity and specificity of the protein/creatinine ratio for significant (≥300 mg) and severe proteinuria (≥5000 mg) that were based on 24-hour urine total protein were calculated.
Results |
A total of 220 women were evaluated; 43.2% of the women were black, and 80% of the women had government insurance. Mean maternal and gestational ages were 26.1 years and 36.5 weeks, respectively. Significant and severe proteinuria on 24-hour urine evaluation were identified in 76.4% and 8.2% of cases, respectively. Regression analysis of protein/creatinine ratio and 24-hour urine total protein level showed a poor correlation (r2=0.41). Receiver operator characteristic analysis revealed an area under the curve of 0.80, but the shoulder value of 390 mg/g carried a high false-negative rate (45.2%). With a more conservative cutoff value, a protein/creatinine ratio of ≥300 mg/g had a poor negative predictive value (47.5%), a specificity for significant proteinuria (55.8%), with a positive predictive value of 85.5%, and a sensitivity of 81%. For severe proteinuria, a protein/creatinine ratio of ≥5000 mg/g had a poor positive predictive value (61.9%) and sensitivity (72.2%), with a negative predictive value of 97.5%, and a specificity of 96.0%.
Conclusion |
Protein/creatinine ratio does not exclude adequately the presence of significant proteinuria or predict severe proteinuria and should not be used as an alternative to 24-hour total protein evaluation.
Le texte complet de cet article est disponible en PDF.Keywords : Preeclampsia, proteinuria, protein/creatinine ratio, 24-hour urine total protein level
Plan
Supported in part by National Center for Research Resources, grant No. M01-RR-000080. Presented at the Twenty-Third Annual Meeting of the Society for Maternal-Fetal Medicine, San Francisco, Calif, February 3-8, 2003. Reprints not available from the authors. |
Vol 189 - N° 3
P. 848-852 - septembre 2003 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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