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Wong NKL, Wah IYM, Wong STK, Nguyen-Hoang L, Lau CSL, Ip PNP, Leung HHY, Sahota DS, Poon LC. A point-of-care urine test to predict adverse maternal and neonatal outcomes in Asian women with suspected preeclampsia. Arch Gynecol Obstet 2024; 310:981-990. [PMID: 37882870 DOI: 10.1007/s00404-023-07257-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/05/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVES To assess clinical utility of the urine Congo red dot test (CRDT) in predicting composite adverse maternal and neonatal outcomes in women with suspected preeclampsia (PE). METHODS CRDT result and pregnancy outcomes were prospectively documented in women with new onset or pre-existing hypertension, new or pre-existing proteinuria, PE symptoms and suspected PE-related fetal growth restriction or abnormal Doppler presenting from 20 weeks' gestation between January 2020 and December 2022. Participants and clinicians were blinded to the CRDT result and managed according to internally agreed protocols. Composite maternal outcome was defined as PE, postpartum hemorrhage, intensive care unit admission, and maternal death. Composite neonatal outcome was defined as small for gestational age, preterm birth, 5-min Apgar score < 7, neonatal intensive care unit admission, and neonatal death. RESULTS Two hundred and forty-four women out of two hundred and fifty-one (97.2%) had a negative CRDT. All seven women with positive CRDT had both adverse maternal and neonatal outcomes, giving positive predictive values (PPV) of 100%. Rates of composite adverse maternal and neonatal outcomes in CDRT negative women were 103/244 [42.2%, 95% confidence interval (CI) 36.2%-48.5%] and 170/244 (69.7%, 95% CI 63.6%-75.1%), respectively. CRDT negative predictive values (NPV) for adverse maternal and neonatal outcomes were, respectively, 141/244 (57.8%, 95% CI 48.6%-68.2%) and 74/244 (30.3%, 95% CI 23.8%-38.1%). CONCLUSION CRDT had low NPV but high PPV for adverse maternal and neonatal outcomes in women with suspected PE. Its role in clinical management and triage of women with suspected PE is limited as it cannot identify those at low risk of developing adverse outcomes.
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Affiliation(s)
- Natalie K L Wong
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Prince of Wales Hospital, 1/F Special Block E, Shatin, Hong Kong, China
| | - Isabella Y M Wah
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Prince of Wales Hospital, 1/F Special Block E, Shatin, Hong Kong, China
| | - Sani T K Wong
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Prince of Wales Hospital, 1/F Special Block E, Shatin, Hong Kong, China
| | - Long Nguyen-Hoang
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Prince of Wales Hospital, 1/F Special Block E, Shatin, Hong Kong, China
| | - Caitlyn S L Lau
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Prince of Wales Hospital, 1/F Special Block E, Shatin, Hong Kong, China
| | - Patricia N P Ip
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Prince of Wales Hospital, 1/F Special Block E, Shatin, Hong Kong, China
| | - Hillary H Y Leung
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Prince of Wales Hospital, 1/F Special Block E, Shatin, Hong Kong, China
| | - Daljit S Sahota
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Prince of Wales Hospital, 1/F Special Block E, Shatin, Hong Kong, China.
| | - Liona C Poon
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Prince of Wales Hospital, 1/F Special Block E, Shatin, Hong Kong, China.
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Wang L, Gao J, Tang P, Hu H, Chen X, Chen Z, Sun Y. Comparing urine point-of-care tests to screen preeclampsia: Congo-red dot paper test versus dipstick urinalysis. J Clin Hypertens (Greenwich) 2024; 26:349-354. [PMID: 38430477 PMCID: PMC11007796 DOI: 10.1111/jch.14783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 03/03/2024]
Abstract
To compare the urine Congo-red dot paper test (CRD) with dipstick urinalysis to screen preeclampsia (PE). A total of 409 paired spot urine samples were obtained prospectively from women with suspected pre-eclampsia attending for routine hospital visits. Congo-red dot paper test and dipstick urinalysis were examined and compared to screen pre-eclampsia. The agreement between the two urinary test is modest (kappa coefficient = 0.28, 95% CI 0.14-0.42). The specificity of CRD was higher than urinalysis (97.4% vs. 90.4%, p < .001). Urinalysis performed better in sensitivity (77.3% vs. 40.9%, p = .04) and the area under the receiver operating characteristic curves (AUC) (0.84 [95% CI 0.74-0.94] vs. 0.69 [95% CI 0.55-0.83], p = .04) than CRD, respectively. The sensitivity, specificity, AUC of the parallel test of them is 86.4% (64.0%-96.4%), 89.1% (85.5%-92.0%), and 0.88 (95% CI 0.79-0.96). And the serial test is 31.8% (14.7%-54.9%), 98.7% (96.8%-99.5%), 0.65 (95% CI 0.51-0.79), accordingly. The urinalysis is a better diagnosing test for preeclampsia. CRD could aid in the diagnosis of patients with preeclampsia. Combined the two tests in suspected patients may further improve the performance in the diagnosis of preeclampsia. Further study need to be made for its potential clinical practice.
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Affiliation(s)
- Liying Wang
- Department of Obstetrics and GynecologyChinese Academy of Medical SciencesPeking Union Medical CollegeNational Clinical Research Center for Obstetric and Gynecologic DiseasesPeking Union Medical College HospitalBeijingChina
| | - Jinsong Gao
- Department of Obstetrics and GynecologyChinese Academy of Medical SciencesPeking Union Medical CollegeNational Clinical Research Center for Obstetric and Gynecologic DiseasesPeking Union Medical College HospitalBeijingChina
| | - Pingping Tang
- Department of Obstetrics and GynecologyChinese Academy of Medical SciencesPeking Union Medical CollegeNational Clinical Research Center for Obstetric and Gynecologic DiseasesPeking Union Medical College HospitalBeijingChina
| | - Huiying Hu
- Department of Obstetrics and GynecologyChinese Academy of Medical SciencesPeking Union Medical CollegeNational Clinical Research Center for Obstetric and Gynecologic DiseasesPeking Union Medical College HospitalBeijingChina
| | - Xiaoxu Chen
- Department of Obstetrics and GynecologyChinese Academy of Medical SciencesPeking Union Medical CollegeNational Clinical Research Center for Obstetric and Gynecologic DiseasesPeking Union Medical College HospitalBeijingChina
| | - Ziyi Chen
- Department of Obstetrics and GynecologyChinese Academy of Medical SciencesPeking Union Medical CollegeNational Clinical Research Center for Obstetric and Gynecologic DiseasesPeking Union Medical College HospitalBeijingChina
| | - Yin Sun
- Department of Obstetrics and GynecologyChinese Academy of Medical SciencesPeking Union Medical CollegeNational Clinical Research Center for Obstetric and Gynecologic DiseasesPeking Union Medical College HospitalBeijingChina
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Hofstee P, Lum JS, Chow YY, Wittwer MR, Arstall M, Dekker G, Clifton VL, Wright IM, Kelly MA, Ecroyd H. Urine congophilia associated with preeclampsia does not persist 6-months postpartum. Placenta 2024; 147:52-58. [PMID: 38316084 DOI: 10.1016/j.placenta.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/14/2023] [Accepted: 01/22/2024] [Indexed: 02/07/2024]
Abstract
INTRODUCTION Preeclampsia is a common hypertensive disorder of pregnancy. Several studies have demonstrated that protein aggregates, detected through urine congophilia, is associated with preeclampsia; however, it has yet to be investigated whether urine congophilia remains postpartum in these women. In this study, we aimed to augment prior studies and determine whether urine congophilia is present postpartum. METHODS Women were recruited from Lyell McEwin Hospital, South Australia. Urine samples were collected during pregnancy and 6-months postpartum from women with non-preeclampsia pregnancies (n = 48) and women with pregnancies complicated by preeclampsia (n = 42). A Congo Red Dot blot test, total protein and creatinine levels from urine, as well as serum Soluble fms-like tyrosine kinase 1 to placental growth factor ratio (sFlt-1:PlGF), were assessed and correlated. RESULTS Preeclamptic women exhibited increased urine congophilia (P < 0.01), sFlt-1:PlGF ratio (P < 0.0001) and total protein (P < 0.01) during pregnancy; with a positive correlation between urine congophilia and total protein across the entire cohort (P < 0.0001). Although urine congophilia was no longer detected 6-months postpartum in preeclamptic women, total protein remained elevated (P < 0.05). sFlt-1:PlGF ratio during pregnancy was positively correlated with congophilia across the cohort (P = 0.0007). Serum creatinine was also higher in preeclamptic women during pregnancy (P < 0.001). DISCUSSION These results support that urine congophilia is significantly elevated in pregnancies complicated with preeclampsia and show that it does not continue postpartum, although larger cohort studies are needed to determine its feasibility as a diagnostic marker.
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Affiliation(s)
- P Hofstee
- Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia; The Tweed Hospital, Northern New South Wales Local Health District, Tweed Heads, NSW, Australia
| | - J S Lum
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW, Australia; Molecular Horizons, University of Wollongong, Wollongong, NSW, Australia
| | - Y Y Chow
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia; Department of Cardiology, Northern Adelaide Local Health Network, Elizabeth Vale, SA, Australia
| | - M R Wittwer
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia; Department of Cardiology, Northern Adelaide Local Health Network, Elizabeth Vale, SA, Australia
| | - M Arstall
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia; Department of Cardiology, Northern Adelaide Local Health Network, Elizabeth Vale, SA, Australia
| | - G Dekker
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia; Department of Obstetrics & Gynaecology, Northern Adelaide Local Health Network, Elizabeth Vale, SA, Australia; Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - V L Clifton
- Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia; Pregnancy and Development Group, Mater Research Institute, University of Queensland South Brisbane, QLD, Australia
| | - I M Wright
- Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia; College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
| | - M A Kelly
- Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia; School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW, Australia.
| | - H Ecroyd
- Molecular Horizons, University of Wollongong, Wollongong, NSW, Australia; School of Chemistry and Molecular Bioscience, University of Wollongong, Wollongong, NSW, Australia.
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Liu X, Xu J, Liu C, Li X. CercaTest Red, a novel urine-based point-of-care test for the detection of preeclampsia. Curr Med Res Opin 2024; 40:395-401. [PMID: 38321953 DOI: 10.1080/03007995.2024.2314245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/31/2024] [Indexed: 02/08/2024]
Abstract
OBJECTIVES Preeclampsia (PE) poses a serious threat to the health of the pregnant woman and her developing fetus due to the difficulty in diagnosing the condition. The disease can develop and worsen suddenly without noticeable signs and symptoms. Thus, there is an urgent need for a simple Point of Care Test (POCT) that improves accessibility to testing and can be used as an aid in the diagnosis of PE. CercaTest Red is a noninvasive detection kit for impending preeclampsia using urine from pregnant women. This is especially pertinent for women who have limited access to secondary/tertiary healthcare as those in remote settings, low-income countries or simply lack of out of hours laboratory services. METHODS The kit employs an absorptive column that separates Congo red dye bound to urinary misfolded protein from pregnant women and unbound dye. When a solution of Congo red dye pre-mixed with urine is loaded onto the absorptive matrix in a detection cuvette, the presence (positive) or absence (negative) of misfolded proteins can be determined based on the color of eluate collected in the lower section of the cuvette. 190 and 937 pregnant women who were >18 years old at the gestational age of ≥20 weeks were enrolled for the feasibility and validation cohort, respectively. The consistency between CercaTest Red and clinical diagnosis of PE according to the American College of Obstetricians and Gynecologist (ACOG) Guidelines was analyzed using the kappa statistic. RESULTS The POCT has a limit of detection (LoD) of human urinary misfolded proteins equivalent to 0.45 μM of denatured human serum albumin, with high reproducibility and stability. An accuracy of 96.84% for diagnosis of preeclampsia with a Kappa statistic of 0.746 (p < 0.001) was validated in a cohort of 937 subjects. CONCLUSION This test is easy to use, cost-effective and portable with short turnaround time and no laboratory instrument requirement. In the future, the test may have the potential to become quantitative using spectroscopy (Chinese Clinical Trial Registry No. ChiCTR1800017692).
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Affiliation(s)
- Xuemin Liu
- Department of Gynaecology and Obstetrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jun Xu
- Shuwen Biotech Co., Ltd, Hangzhou, Zhejiang, China
| | - Chao Liu
- Shuwen Biotech Co., Ltd, Hangzhou, Zhejiang, China
| | - Xingmin Li
- Shuwen Biotech Co., Ltd, Hangzhou, Zhejiang, China
- Cerca Biotech GmbH, Berlin, Germany
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Medegan Fagla B, Buhimschi IA. Protein Misfolding in Pregnancy: Current Insights, Potential Mechanisms, and Implications for the Pathogenesis of Preeclampsia. Molecules 2024; 29:610. [PMID: 38338354 PMCID: PMC10856193 DOI: 10.3390/molecules29030610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/19/2024] [Accepted: 01/21/2024] [Indexed: 02/12/2024] Open
Abstract
Protein misfolding disorders are a group of diseases characterized by supra-physiologic accumulation and aggregation of pathogenic proteoforms resulting from improper protein folding and/or insufficiency in clearance mechanisms. Although these processes have been historically linked to neurodegenerative disorders, such as Alzheimer's disease, evidence linking protein misfolding to other pathologies continues to emerge. Indeed, the deposition of toxic protein aggregates in the form of oligomers or large amyloid fibrils has been linked to type 2 diabetes, various types of cancer, and, in more recent years, to preeclampsia, a life-threatening pregnancy-specific disorder. While extensive physiological mechanisms are in place to maintain proteostasis, processes, such as aging, genetic factors, or environmental stress in the form of hypoxia, nutrient deprivation or xenobiotic exposures can induce failure in these systems. As such, pregnancy, a natural physical state that already places the maternal body under significant physiological stress, creates an environment with a lower threshold for aberrant aggregation. In this review, we set out to discuss current evidence of protein misfolding in pregnancy and potential mechanisms supporting a key role for this process in preeclampsia pathogenesis. Improving our understanding of this emerging pathophysiological process in preeclampsia can lead to vital discoveries that can be harnessed to create better diagnoses and treatment modalities for the disorder.
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Affiliation(s)
| | - Irina Alexandra Buhimschi
- Department of Obstetrics and Gynecology, College of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA;
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Fedotov SA, Khrabrova MS, Vashukova ES, Glotov AS, Anpilova AO, Dobronravov VA, Velizhanina ME, Rubel AA. Diagnostics of preeclampsia based on Congo red binding to urinary components: Rationales and limitations. PLoS One 2024; 19:e0297144. [PMID: 38241324 PMCID: PMC10798433 DOI: 10.1371/journal.pone.0297144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/28/2023] [Indexed: 01/21/2024] Open
Abstract
Preeclampsia is a disorder that can occur during pregnancy and is one of the leading causes of death among pregnant women. This disorder occurs after the 20th week of pregnancy and is characterized by arterial hypertension, proteinuria, fetoplacental, and multiple organ dysfunctions. Despite the long history of studying preeclampsia, its etiology and pathogenesis remain poorly understood, and therapy is symptomatic. One of the factors of the disorder is believed to be misfolded proteins that are prone to form amyloid aggregates. The CRD tests, utilizing the binding of the amyloid-specific dye Congo red to urine components, demonstrate high efficiency in diagnosing preeclampsia. However, these tests have also been found to be positive in other disorders with proteinuria, presumably associated with concomitant amyloidosis. To assess the limitations of the CRD tests, we examined urine congophilia and protein components mediating Congo red positivity in patients with proteinuria, including preeclampsia, amyloid and non-amyloid nephropathies. We stained the urine samples and calculated congophilia levels. We also assessed the contribution of large protein aggregates to congophilia values using ultracentrifugation and determined the molecular weights of congophilic urinary proteins using centrifugal concentrators. All proteinuric groups demonstrate positive results in the CRD tests and congophilia levels were more than two times higher compared with the control non-proteinuric groups (p <0.01). There was a strong correlation between urine protein excretion and congophilia in amyloid nephropathy (rs = 0.76), non-amyloid nephropathies (rs = 0.90), and preeclampsia (rs = 0.90). Removal of large aggregates from urine did not affect the congophilia levels. Separation of urine protein fractions revealed congophilic components in the range of 30-100 kDa, including monomeric serum albumin. Our results indicate limitations of CRD tests in preeclampsia diagnostics in women with renal disorders and underscore the need for further research on the mechanisms of Congo red binding with urine components.
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Affiliation(s)
- Sergei A. Fedotov
- Laboratory of Amyloid Biology, Saint Petersburg University, St. Petersburg, Russia
- Laboratory of Toxinology and Molecular Systematics, L.A. Orbeli Institute of Physiology, National Academy of Sciences of the Republic of Armenia, Yerevan, Armenia
- Laboratory of Comparative Behavioral Genetics, Pavlov Institute of Physiology, Russian Academy of Sciences, St. Petersburg, Russia
| | - Maria S. Khrabrova
- Laboratory of Amyloid Biology, Saint Petersburg University, St. Petersburg, Russia
- Department of Propaedeutics of Internal disease, Pavlov University, St. Petersburg, Russia
| | - Elena S. Vashukova
- Department of Genomic Medicine, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, St. Petersburg, Russia
| | - Andrey S. Glotov
- Department of Genomic Medicine, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, St. Petersburg, Russia
| | - Anastasia O. Anpilova
- Laboratory of Amyloid Biology, Saint Petersburg University, St. Petersburg, Russia
- Research Institute of Nephrology, Pavlov University, St. Petersburg, Russia
| | | | - Maria E. Velizhanina
- Laboratory of Amyloid Biology, Saint Petersburg University, St. Petersburg, Russia
| | - Aleksandr A. Rubel
- Laboratory of Amyloid Biology, Saint Petersburg University, St. Petersburg, Russia
- Department of Genetics and Biotechnology, St. Petersburg State University, St. Petersburg, Russia
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Younis D, Mosbah A, Zakaria MM, Awadalla A, El-Kannishy G, Shemies RS. Urinary congophilia in pregnancy: a marker of kidney injury rather than preeclampsia. J Hypertens 2023; 41:1760-1767. [PMID: 37602468 DOI: 10.1097/hjh.0000000000003531] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
BACKGROUND The differentiation between preeclampsia and similarly presenting kidney disease in pregnancy is a diagnostic challenge. Although some laboratory tests have been utilized, globally validated tools are yet needed, particularly in resource-limited settings. Congophilic proteins are abundantly detected in the urine of pregnant women who develop preeclampsia that is thought to be a marker of disease process. The present study aimed to assess the diagnostic and predictive utility of urinary congophilia in pregnant women with hypertensive disorders of pregnancy as well as kidney diseases. METHODS This cohort study included 157 pregnant women, classified as healthy controls ( n = 38), preeclampsia/eclampsia ( n = 45), gestational hypertension ( n = 9), chronic hypertension ( n = 8), chronic kidney disease (CKD) ( n = 27), and pregnancy-related acute kidney injury (PR-AKI) ( n = 30). Urinary congophilia was assessed by Congo Red Dot Blot assay. RESULTS Congo red retention (CRR) values were significantly higher in women with preeclampsia/eclampsia ( P ≤ 0.001), chronic hypertension ( P = 0.029), gestational hypertension ( P = 0.017), CKD ( P ≤ 0.001), PR-AKI secondary to preeclampsia ( P ≤ 0.001), and PR-AKI secondary to other causes ( P = 0.001), compared with healthy controls. Women with preeclampsia, CKD, and PR-AKI (non-preeclampsia related) exhibited the highest levels of CRR. CRR positively correlated to proteinuria ( P = 0.006) and serum creatinine ( P = 0.027). CRR did not significantly vary between women who presented antepartum and those presented postpartum after removal of the placenta ( P = 0.707). CRR at a cut-off point of at least 1.272 had 91% specificity and 61.1% sensitivity in predicting renal recovery in PR-AKI patients. CRR had a poor specificity in discriminating preeclampsia from the other clinical presentations. CONCLUSION Urinary congophilia could not discriminate preeclampsia from similarly presenting kidney diseases in pregnancy. Further studies are needed to improve differentiation of these conditions.
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Affiliation(s)
| | | | - Mahmoud M Zakaria
- Clinical Pathology Department, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt
| | - Amira Awadalla
- Clinical Pathology Department, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt
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Wong STK, Sahota DS, Wong NKL, Wah IYM, Wang X, Lau SL, Chiu CPH, Ip PNP, Poon LC. A point-of care urine test to predict preeclampsia development in Asian women with suspected preeclampsia. Pregnancy Hypertens 2023; 32:28-34. [PMID: 37003112 DOI: 10.1016/j.preghy.2023.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/09/2023] [Accepted: 03/21/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVES To evaluate the diagnostic performance and clinical utility of the urine Congo red dot test (CRDT) in predicting preeclampsia (PE) within 7 days, 14 days and 28 days of assessment. STUDY DESIGN A prospective single center double blind non-intervention study conducted from January 2020 to March 2022. Urine congophilia has been proposed as a point-of-care test for the prediction and rapid identification of PE. In our study, urine CRDT and pregnancy outcomes were assessed in women presenting with clinical features of suspected PE after 20 weeks of gestation. RESULTS Among the 216 women analyzed, 78 (36.1 %) women developed PE, in which only 7 (9.0 %) of them had a positive urine CRDT test. The median (IQR) interval between the initial test and the diagnosis of PE was significantly shorter for women with a positive urine CRDT compared with women with a negative urine CRDT (1 day (0-5 days) vs 8 days (1-19 days), P = 0.027). The negative predictive value of a negative urine CRDT test for PE within 7 days, 14 days and 28 days of assessment were 83.73 % (95 %CI 81.75 %- 85.54 %), 78.92 % (95 % confidence interval [CI] 77.07 %- 80.71 %) and 71.77 % (95 %CI 70.06 %- 73.42 %) respectively. The sensitivity of the urine CRDT in ruling in PE within 7 days, 14 days and 28 days of assessment were 17.07 % (95 %CI 7.15 %- 32.06 %), 13.73 % (95 %CI 5.70 %- 26.26 %) and 10.61 % (95 %CI 4.37 %- 20.64 %), respectively. CONCLUSIONS Urine CRDT alone has high specificity yet low sensitivity in the short-term prediction of PE in women with suspected PE. Further studies are required to evaluate its clinical utility.
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Affiliation(s)
- Sani T K Wong
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - Daljit S Sahota
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong.
| | - Natalie K L Wong
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - Isabella Y M Wah
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - Xueqin Wang
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - S L Lau
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - C P H Chiu
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - Patricia N P Ip
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - Liona C Poon
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong.
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9
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Khaliq OP, Phoswa WN, Moodley J. The effectiveness of the Congo Red Dot paper test in hypertensive disorders of pregnancy: A systematic review and meta-analysis. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1120937. [PMID: 36864848 PMCID: PMC9972081 DOI: 10.3389/frph.2023.1120937] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 01/11/2023] [Indexed: 02/16/2023] Open
Abstract
Background Congo Red Dot Paper Test (CRDPT) appears to be a simple, cost-effective, non-invasive diagnostic tool for hypertensive disorders of pregnancy (HDP). The main objective of the study is to assess the effectiveness of CRDPT in detecting HDP. Methods This is a systemic review and meta-analysis of published studies on the effectiveness of CRDPT in the detection of HDP. The study was conducted in line with the PRISMA-DTA guidelines. The PICOS framework was used to search for relevant articles using Medline, PubMed, Google Scholar, Web of Science, and the Cochrane Library databases. The articles were screened against a set of inclusion and exclusion criteria and analysed using the Review Manager 5.4 software. Results A title, abstract and full article screening was conducted on 18,153 potential articles based on the inclusion and exclusion criteria. The screening yielded five articles for meta-analysis. The total number of normotensive pregnant women (n = 3,380) in the included studies was five times higher than the total number of women with pre-eclampsia (n = 535). A difference between the HDP and normotensive group was noted. This is indicated by a significantly decreased in the effectiveness of CRDPT in detecting HDP as compared to normotensive group [Risk Ratio (RR) = 6.32 (2.17, 18.43) p < 0.00001]. The included studies had a high nature of heterogeneity (I 2 = 98%, p < 0.00001) partially due to different study designs included in the analysis and different regions where studies were conducted given that none of these studies were conducted in African countries where HDP is prominent. Conclusions According to results generated from 5 studies in this meta-analysis, it was found that CRDPT might not be effective in the detection of hypertensive disorder of pregnancy. Moreover, more research, especially in African women where hypertensive disorders of pregnancy are prevalent, are re-quired to ascertain these findings. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021283679, identifier: CRD42021283679.
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Affiliation(s)
- O. P. Khaliq
- Department of Obstetrics and Gynaecology and Women’s Health and HIV Research Group, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa,Correspondence: O. P. Khaliq
| | - W. N. Phoswa
- Department of Life and Consumer Sciences, University of South Africa, Science Campus, Roodepoort, South Africa
| | - J. Moodley
- Department of Obstetrics and Gynaecology and Women’s Health and HIV Research Group, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
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Petca A, Sinescu R, Sandru F, Petca RC, Dumitrascu M, Mehedintu C, Zvanca M. New approaches in predicting and diagnosing preeclampsia: Congo Red Dot Paper Test (Review). Exp Ther Med 2022; 23:270. [DOI: 10.3892/etm.2022.11196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/07/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Aida Petca
- Deparment of Obstetrics and Gynecology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Ruxandra Sinescu
- Department of Plastic Surgery and Reconstructive Microsurgery, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Florica Sandru
- Department of Dermatology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Razvan-Cosmin Petca
- Department of Urology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Mihai Dumitrascu
- Deparment of Obstetrics and Gynecology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Claudia Mehedintu
- Deparment of Obstetrics and Gynecology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Mona Zvanca
- Deparment of Obstetrics and Gynecology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Proteomic Analysis of Maternal Urine for the Early Detection of Preeclampsia and Fetal Growth Restriction. J Clin Med 2021; 10:jcm10204679. [PMID: 34682802 PMCID: PMC8537852 DOI: 10.3390/jcm10204679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 12/30/2022] Open
Abstract
Background: To explore the use of maternal urine proteome for the identification of preeclampsia biomarkers. Methods: Maternal urine samples from women with and without preeclampsia were used for protein discovery followed by a validation study. The targeted proteins of interest were then measured in urine samples collected at 20–24 and 30–34 weeks among nine women who developed preeclampsia, one woman with fetal growth restriction, and 20 women with uncomplicated pregnancies from a longitudinal study. Protein identification and quantification was obtained using liquid chromatography–tandem mass spectrometry (LC–MS/MS). Results: Among the 1108 urine proteins quantified in the discovery study, 21 were upregulated in preeclampsia and selected for validation. Nineteen (90%) proteins were confirmed as upregulated in preeclampsia cases. Among them, two proteins, ceruloplasmin and serpin A7, were upregulated at 20–24 weeks and 30–34 weeks of gestation (p < 0.05) in cases of preeclampsia, and could have served to identify 60% of women who subsequently developed preeclampsia and/or fetal growth restriction at 20–24 weeks of gestation, and 78% at 30–34 weeks, for a false-positive rate of 10%. Conclusions: Proteomic profiling of maternal urine can differentiate women with and without preeclampsia. Several proteins including ceruloplasmin and serpin A7 are upregulated in maternal urine before the diagnosis of preeclampsia and potentially fetal growth restriction.
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von Dadelszen P, Vidler M, Tsigas E, Magee LA. Management of Preeclampsia in Low- and Middle-Income Countries: Lessons to Date, and Questions Arising, from the PRE-EMPT and Related Initiatives. MATERNAL-FETAL MEDICINE 2021. [DOI: 10.1097/fm9.0000000000000096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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