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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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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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Avendanha RA, Campos GFC, Branco BC, Ishii NC, Gomes LHN, de Castro AJ, Leal CRV, Simões E Silva AC. Potential urinary biomarkers in preeclampsia: a narrative review. Mol Biol Rep 2024; 51:172. [PMID: 38252179 DOI: 10.1007/s11033-023-09053-5] [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: 05/03/2023] [Accepted: 10/30/2023] [Indexed: 01/23/2024]
Abstract
INTRODUCTION Preeclampsia (PE) is a highly relevant pregnancy-related disorder. An early and accurate diagnosis is crucial to prevent major maternal and neonatal complications and mortality. Due to the association of kidney dysfunction with the pathophysiology of the disease, urine samples have the potential to provide biomarkers for PE prediction, being minimally invasive and easy to perform. Therefore, searching for novel biomarkers may improve outcomes. This narrative review aimed to summarize the scientific literature about the traditional and potential urinary biomarkers in PE and to investigate their applicability to screen and diagnose the disorder. METHODS A non-systematic search was performed in PubMed/MEDLINE, Scopus, and SciELO databases. RESULTS There is significant divergence in the literature regarding traditionally used serum markers creatinine, cystatin C, and albuminuria, accuracy in PE prediction. As for the potential renal biomarkers investigated, including vascular epithelial growth factor (VEGF), placental growth factor (PlGF), and soluble fms-like tyrosine kinase (sFlt-1), urinary levels of PlGF and sFtl-1/PlGF ratio in urine seem to be the most promising as screening tests. The assessment of the global load of misfolded proteins through urinary congophilia, podocyturia, and nephrinuria has also shown potential for screening and diagnosis. Studies regarding the use of proteomics and metabolomics have shown good accuracy, sensitivity, and specificity for predicting the development and severity of PE. CONCLUSION However, there are still many divergences in the literature, which requires future and more conclusive research to confirm the predictive role of urinary biomarkers in pregnant women with PE.
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Affiliation(s)
- Renata Araujo Avendanha
- Liga Acadêmica de Pesquisa Científica, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | | | - Beatriz Castello Branco
- Liga Acadêmica de Pesquisa Científica, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, UFMG, Belo Horizonte, MG, Brazil
| | - Nicolle Coimbra Ishii
- Liga Acadêmica de Pesquisa Científica, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
- Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, Minas Gerais, Brazil
| | - Luiz Henrique Nacife Gomes
- Liga Acadêmica de Pesquisa Científica, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
- Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ailton José de Castro
- Liga Acadêmica de Pesquisa Científica, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Caio Ribeiro Vieira Leal
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina, UFMG, Belo Horizonte, Minas Gerais, Brazil
| | - Ana Cristina Simões E Silva
- Liga Acadêmica de Pesquisa Científica, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil.
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, UFMG, Belo Horizonte, MG, Brazil.
- Faculdade de Medicina, UFMG, Avenida Alfredo Balena, 190, 2o andar, sala 281. Bairro Santa Efigênia, Belo Horizonte, CEP 30130-100, MG, Brazil.
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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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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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Rani A, Jain M, Dash D, Mishra SP, Mohammadzadehasl M. A Study of Role of Urinary Congophilia in Early Detection of Preeclampsia. ANNALS OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES (INDIA) 2022. [DOI: 10.1055/s-0042-1743134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
Introduction Preeclampsia and eclampsia are important causes of maternal morbidity. Preeclapmtic women secrete misfolded proteins in the urine. Buhimschi et al had developed a new test for diagnosis of preeclampsia. This test is based on staining of misfolded protein with Congo red dye. Misfolded proteins are derived from syncytiotrophoblast microparticles (STBMs). These STBM are membrane bound vesicles and contain misfolded proteins. In preeclampsia, glomeruli of kidneys are disrupted and these damaged protein reach the urine.
Aim and Objective This study aimed to investigate the role of urinary congophilia in early prediction of preeclampsia.
Materials and Methods This test was done in 250 pregnant women attending the Gynaecological Outpatient Department. Urine sample of early morning was taken and test was done in the Department of Biochemistry. The included pregnant women were of gestational age between 14 and 18 weeks. The staining of urine with Congo red dye was done and washed with methanol. The retention of dye was interpreted with naked eye. The more retention of dye, the more chances of developing preeclampsia later. The patients were followed-up till delivery. The patents who developed preeclampsia later part of pregnancy were recorded. Mean arterial pressure (MAP) and past history and body mass index were also recorded.
Results Out of 250 patients, 30 developed preeclampsia later. A total of 34 patients were having positive urinary congophilia and only 20 patients developed preeclampsia later. MAP more than 90 mm Hg is abnormal but 66.7% of patients who developed preeclampsia had MAP >90 mm Hg. In 16.7% of patients, who developed preeclampsia later, had positive past history of hypertension. In 66.7% of patients, who were positive for urinary congophilia, later developed preeclampsia.
Conclusion Preeclampsia and eclampsia are important causes of maternal mortality and morbidity. So, early detection can prevent complications and timely management. Urinary congophilia is one of such test which can help in early prediction of preeclampsia. If it is combined with past maternal history and MAP, it gives more good results. The detection rate is much higher if signs and symptoms of preeclampsia are noticed timely.
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Affiliation(s)
- Anjali Rani
- Department of Obstetrics and Gynaecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Madhu Jain
- Department of Obstetrics and Gynaecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Debabrata Dash
- Department of Biochemistry, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Surendra P. Mishra
- Department of Biochemistry, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Milad Mohammadzadehasl
- Department of Obstetrics and Gynaecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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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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Cai B, Yuan X, Li X, Xu J, Du J. Urinary Congophilia Confirmed With the CapCord Test Is Associated With Pregnancy Outcomes in Women With Early-Onset Pre-eclampsia. Front Med (Lausanne) 2021; 8:700157. [PMID: 34409051 PMCID: PMC8365157 DOI: 10.3389/fmed.2021.700157] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The association between misfolded proteins presented in the urine of pregnant women and pregnancy outcomes associated with early-onset pre-eclampsia (PE) remains unclear. This study aimed to investigate this association to examine the predictive value of urinary congophilia in the prognostication of pregnancy outcomes in this patient group in the Chinese population. Materials and Methods: This study included 1,397 patients, of which 46, 147, and 8 patients had gestational hypertension, PE, and chronic hypertension, respectively, and 1,196 were healthy controls undergoing the CapCord test for urinary congophilia. Patients with PE were divided into early- and late-onset groups. Patients with early-onset PE were further divided into iatrogenic prematurity and full-term delivery groups, the rates of urinary congophilia were compared between the groups; additionally, this patient group was divided into positive and negative urinary congophilia groups, clinical characteristics and pregnancy outcomes were compared between the groups. Univariate and multivariate logistic regression analyses were performed. Results: A total of 113 (76.9%) of 147 patients in the PE group had urinary congophilia; this rate was higher than that observed in the other three groups (χ2 = 780.892, p < 0.001). Gestational age in the early-onset PE group at both onset and delivery was lower than that in the late-onset PE group (p < 0.001). The rates of iatrogenic prematurity and hemolysis, elevated liver enzymes, and low platelet count syndrome were both higher in the early-onset PE group than in the late-onset PE group (p < 0.001, p < 0.05). In addition, the rate of urinary congophilia in the early-onset PE group was higher than that in the late-onset PE group (χ2 = 13.297, p < 0.001). Urinary congophilia was an independent risk factor for iatrogenic prematurity among patients with early-onset PE in both univariate [odds ratio (OR) 17.143, 95% confidence interval (CI): 4.719–62.271; p < 0.001] and multivariate (OR 18.174; 95% CI: 4.460–74.063; p < 0.001) analyses. Patients with early-onset PE and urinary congophilia were more likely than their counterparts without urinary congophilia to deliver at a lower gestational age, present with iatrogenic prematurity, and have a shorter latency period between onset and delivery. Conclusion: Urinary congophilia confirmed with the CapCord test may help predict pregnancy outcomes in patients with early-onset PE.
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Affiliation(s)
- Benshuo Cai
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | | | - Xingmin Li
- Shuwen Biotech Company Ltd., Deqing, China
| | - Jun Xu
- Shuwen Biotech Company Ltd., Deqing, China
| | - Juan Du
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
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Döbert M, Varouxaki AN, Mu AC, Syngelaki A, Nicolaides KH. Screening for late preeclampsia at 35-37 weeks by the urinary Congo-red dot paper test. J Matern Fetal Neonatal Med 2021; 35:5686-5690. [PMID: 34182860 DOI: 10.1080/14767058.2021.1888924] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Several cross-sectional studies have investigated the incidence of urinary Congo-red dye positivity in women with preeclampsia (PE), compared to unaffected pregnancies, and reported very high sensitivity and low false positive rate in the diagnosis of PE. OBJECTIVE To determine the performance of the urinary Congo-red dot paper test at 35-37 weeks' gestation in the prediction of delivery with PE at ≤2 and >2 weeks after assessment. METHODS This was a prospective observational study in women attending for a routine hospital visit at 35+0 to 36+6 weeks' gestation in a maternity hospital in England. Urine samples were collected and the Congo-red dot paper test was used to assess the degree of Congo-red dye positivity. The test uses a scoring system from 1 to 8 and the higher the score the greater the degree of Congo-red dye positivity. We examined and compared the degree of Congo-red dye positivity in the groups that delivered with PE at ≤2 and >2 weeks with those that remained normotensive. Reproducibility was assessed by examining the inter- and intra-observer reliability of scoring on stored images with the researchers blinded to previous results. RESULTS The study population of 2140 women included 46 (2.1%) that subsequently developed PE (2.1%). The urinary Congo-red dot test was positive in 8.3% (1/12) and 2.9% (1/34) that delivered with PE at ≤2 and >2 weeks from assessment and in 0.2% (4/2094) of the unaffected pregnancies when the cutoff for Congo-red dye positivity was ≥5. The respective values when the cutoff used was ≥3 were 66.7%, 23.5%, and 16.5%, respectively. The intraclass correlation coefficient for the inter-observer reliability was 0.926 (95% CI 0.890-0.953, p<.0001) and Cohen's kappa coefficient for the intra-observer reliability was 0.904, p<.0001. CONCLUSIONS The performance of the urinary Congo-red dot paper test at 35-37 weeks' gestation in the prediction of PE is very poor.
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Affiliation(s)
- Moritz Döbert
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | | | - An Chi Mu
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - Argyro Syngelaki
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - Kypros H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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Sailakshmi MPA, Prabhu MR, Prabhakara S, Anbazhagan K, Rupakala BM. Congo red dot test in the early prediction and diagnosis of pre-eclampsia in a tertiary health care centre in India. Pregnancy Hypertens 2021; 25:225-229. [PMID: 34273671 DOI: 10.1016/j.preghy.2021.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/04/2021] [Accepted: 06/05/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To demonstrate the use of urine congophilia quantification in the prediction and diagnosis of pre-eclampsia using Congo red dot test. STUDY DESIGN A prospective cohort study in 378 consecutive pregnant women was conducted. All eligible, consenting women of gestational age between 10 and 34 weeks were enrolled in the study. The presence of urinary misfolded proteins was screened by a simple dot test technique on unsupported nitrocellulose membrane using Congo red dye. RESULTS The urinary congophilia was increased in urine from women with pre eclampsia compared to healthy pregnant controls. The mean CRR value of pre eclamptic pregnant women (35.2 ± 9.4%) was five times higher than that of mean CRR value of normotensive pregnant women (6.9 ± 4.7%). The mean gestational age at which Congo red test showed positive was 26.95 ± 2.90 weeks and the time taken from CRD positive to development of PE was 4.92 ± 2.54 weeks of gestation. CONCLUSIONS In our study, the CRD test was not only effective in predicting pre-eclampsia but was also useful in differentiating between pre-eclampsia and other forms of hypertension, as well as early onset and late onset pre-eclampsia, with positive predictive value of 80.36% and negative predictive value of 92.86.
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Affiliation(s)
- M P A Sailakshmi
- Department of OBG, Rajarajeswari Medical College and Hospital, Bangalore, India.
| | - M R Prabhu
- Department of Molecular Medicine, Rajarajeswari Medical College and Hospital, Bangalore, India
| | - S Prabhakara
- Department of Genetics, Rajarajeswari Medical College and Hospital, Bangalore, India
| | - K Anbazhagan
- Department of Molecular Medicine, Rajarajeswari Medical College and Hospital, Bangalore, India.
| | - B M Rupakala
- Department of OBG, Rajarajeswari Medical College and Hospital, Bangalore, India
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Bracken H, Buhimschi IA, Rahman A, Smith PRS, Pervin J, Rouf S, Bousieguez M, López LG, Buhimschi CS, Easterling T, Winikoff B. Congo red test for identification of preeclampsia: Results of a prospective diagnostic case-control study in Bangladesh and Mexico. EClinicalMedicine 2021; 31:100678. [PMID: 33385127 PMCID: PMC7770484 DOI: 10.1016/j.eclinm.2020.100678] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/17/2020] [Accepted: 11/24/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Misfolded proteins in the urine of women with preeclampsia bind to Congo Red dye (urine congophilia). We evaluated a beta prototype of a point-of-care test for the identification of urine congophilia in preeclamptic women. METHODS Prospective diagnostic case-control study conducted in 409 pregnant women (n = 204 preeclampsia; n = 205 uncomplicated pregnancies) presenting for delivery in two tertiary level hospitals located in Bangladesh and Mexico. The GV-005, a beta prototype of a point-of-care test for detecting congophilia, was performed on fresh and refrigerated urine samples. The primary outcome was the prevalence of urine congophilia in each of the two groups. Secondary outcome was the likelihood of the GV-005 (index test) to confirm and rule-out preeclampsia based on an adjudicated diagnosis (reference standard). FINDINGS The GV-005 was positive in 85% of clinical cases (83/98) and negative in 81% of clinical controls (79/98) in the Bangladesh cohort. In the Mexico cohort, the GV-005 test was positive in 48% of clinical cases (51/106) and negative in 77% of clinical controls (82/107). Adjudication confirmed preeclampsia in 92% of Bangladesh clinical cases (90/98) and 61% of Mexico clinical cases (65/106). The odds ratio of a urine congophilia in adjudicated cases versus controls in the Bangladesh cohort was 34.5 (14.7 - 81.1) (p<0.001) compared to 4.2 (2.1 - 8.4; p<0.001) in the Mexico cohort. INTERPRETATION The GV-005, a beta prototype of a point-of-care test for detection of urine congophilia, is a promising tool for rapid identification of preeclampsia. FUNDING Saving Lives at Birth.
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Affiliation(s)
- Hillary Bracken
- Gynuity Health Projects, 220 East 42nd Street, Suite #710, New York, NY 10017, USA
- Corresponding author.
| | - Irina A. Buhimschi
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, College of Medicine, Chicago, IL 60612, USA
| | - Anisur Rahman
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | | | - Jesmin Pervin
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | - Salma Rouf
- Department of Obstetrics and Gynecology, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Manuel Bousieguez
- Gynuity Health Projects, 220 East 42nd Street, Suite #710, New York, NY 10017, USA
| | | | - Catalin S. Buhimschi
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, College of Medicine, Chicago, IL 60612, USA
| | | | - Beverly Winikoff
- Gynuity Health Projects, 220 East 42nd Street, Suite #710, New York, NY 10017, USA
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12
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Differential Diagnosis of Preeclampsia Based on Urine Peptidome Features Revealed by High Resolution Mass Spectrometry. Diagnostics (Basel) 2020; 10:diagnostics10121039. [PMID: 33287124 PMCID: PMC7761751 DOI: 10.3390/diagnostics10121039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/25/2020] [Accepted: 12/01/2020] [Indexed: 11/16/2022] Open
Abstract
Preeclampsia (PE) is a severe pregnancy complication, which may be considered as a systemic response in the second half of pregnancy to physiological failures in the first trimester, and can lead to very serious consequences for the health of the mother and fetus. Since PE is often associated with proteinuria, urine proteomic assays may represent a powerful tool for timely diagnostics and appropriate management. High resolution mass spectrometry was applied for peptidome analysis of 127 urine samples of pregnant women with various hypertensive complications: normotensive controls (n = 17), chronic hypertension (n = 16), gestational hypertension (n = 15), mild PE (n = 25), severe PE (n = 25), and 29 patients with complicated diagnoses. Analysis revealed 3869 peptides, which mostly belong to 116 groups with overlapping sequences. A panel of 22 marker peptide groups reliably differentiating PE was created by multivariate statistics, and included 15 collagen groups (from COL1A1, COL3A1, COL2A1, COL4A4, COL5A1, and COL8A1), and single loci from alpha-1-antitrypsin, fibrinogen, membrane-associated progesterone receptor component 1, insulin, EMI domain-containing protein 1, lysine-specific demethylase 6B, and alpha-2-HS-glycoprotein each. ROC analysis of the created model resulted in 88% sensitivity, 96.8% specificity, and receiver operating characteristic curve (AUC) = 0.947. Obtained results confirm the high diagnostic potential of urinary peptidome profiling for pregnancy hypertensive disorders diagnostics.
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13
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Li XM, Liu XM, Xu J, Du J, Cuckle H. Late pregnancy screening for preeclampsia with a urinary point-of-care test for misfolded proteins. PLoS One 2020; 15:e0233214. [PMID: 32433710 PMCID: PMC7239432 DOI: 10.1371/journal.pone.0233214] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/17/2020] [Indexed: 11/18/2022] Open
Abstract
The aim was to describe and assess a new late pregnancy point-of-care urinary preeclampsia screening test. Urine samples were collected from a consecutive series of 1,532 pregnant women hospitalized at 20-41 weeks gestation in a Chinese single obstetric unit. A simple disposable Congo red based device was newly developed and employed to prospectively test misfolded proteins in pregnant women's urine. A total of 140 preeclampsia cases were clinically diagnosed, 101 severe and 87 pre-term. Detection and false positive rates were similar in the training and validation subsets with combined 74% and 3.0%. The detection rate was 83% in severe, 86% in pre-term, 49% and 50% in mild and term cases (P<0.0001) respectively. In conclusion, a simple point-of-care urinary test for misfolded proteins can be used to screen for preeclampsia in late pregnancy with very high screening performance. To the best of our knowledge, this is the first study to screen for preeclampsia using Congo red based device in Chinese pregnant population.
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Affiliation(s)
- Xing-Min Li
- Shuwen Biotech Co. Ltd, Deqing, Zhejiang Province, China
- * E-mail:
| | - Xue-Min Liu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Jun Xu
- Shuwen Biotech Co. Ltd, Deqing, Zhejiang Province, China
| | - Juan Du
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Howard Cuckle
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York City, New York, United States of America
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14
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Sergeeva VA, Zakharova NV, Bugrova AE, Starodubtseva NL, Indeykina MI, Kononikhin AS, Frankevich VE, Nikolaev EN. The high-resolution mass spectrometry study of the protein composition of amyloid-like urine aggregates associated with preeclampsia. EUROPEAN JOURNAL OF MASS SPECTROMETRY (CHICHESTER, ENGLAND) 2020; 26:158-161. [PMID: 31291787 DOI: 10.1177/1469066719860076] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The study of protein misfolding and post-translational processing abnormalities is a promising diagnostic approach for socially significant pathologies associated with the accumulation of abnormal forms of proteins. Recently, it was shown that amyloid-like aggregates can be observed in the urine of pregnant women with preeclampsia, which is the most severe hypertensive complication that can lead to fateful outcomes. The protein composition of urine aggregates may clarify the molecular mechanisms underlying the pathology and has not yet been studied in detail. Using a proteomic approach based on high-resolution mass spectrometry, we studied the protein composition of amyloid-like structures that aggregate in the presence of Congo red azo-dye in the urine of pregnant women with preeclampsia. Fragments of β-sheets of α-1-antitrypsin, complement 3, haptoglobin, ceruloplasmin, and trypstatin were identified as most likely targets for Congo red binding.
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Affiliation(s)
- Victoria A Sergeeva
- Emanuel Institute for Biochemical Physics, Russian Academy of Sciences, Moscow, Russia
- V.L. Talrose Institute for Energy Problems of Chemical Physics, N.N. Semenov Federal Center of Chemical Physic of RAS, Moscow, Russia
| | - Natalia V Zakharova
- Emanuel Institute for Biochemical Physics, Russian Academy of Sciences, Moscow, Russia
| | - Anna E Bugrova
- Emanuel Institute for Biochemical Physics, Russian Academy of Sciences, Moscow, Russia
- V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Natalia L Starodubtseva
- Emanuel Institute for Biochemical Physics, Russian Academy of Sciences, Moscow, Russia
- V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Maria I Indeykina
- Emanuel Institute for Biochemical Physics, Russian Academy of Sciences, Moscow, Russia
| | - Alexey S Kononikhin
- V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
- Skolkovo Institute of Science and Technology, Moscow, Russia
| | - Vladimir E Frankevich
- V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
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15
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Scioscia M, Noventa M, Cavallin F, Straface G, Pontrelli G, Fattizzi N, Libera M, Rademacher TW, Robillard PY. Exploring strengths and limits of urinary D-chiro inositol phosphoglycans (IPG-P) as a screening test for preeclampsia: A systematic review and meta-analysis. J Reprod Immunol 2019; 134-135:21-27. [PMID: 31382126 DOI: 10.1016/j.jri.2019.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/30/2019] [Accepted: 07/25/2019] [Indexed: 12/24/2022]
Abstract
Preeclampsia is a severe complication of human pregnancy as it leads to significant maternal and perinatal mortality and morbidity worldwide. A prompt recognition of women that develop this syndrome can improve clinical management, increase surveillance and, finally, improve outcomes. Different methods (based on history, ultrasound, serum and urinary biomarkers) were proposed a screening tests for this disease but their performance showed limited results. Urinary inositol phosphoglycans P-type (IPG-P) were shown to identify in advance most of the women who will develop preeclampsia in case-control and longitudinal studies, so we undertook a systematic review and meta-analysis of published studies. Seven studies met the entry criteria so were evaluated. All case-control studies showed excellent statistical performances in a quality statistical assessment. The meta-analysis considered three longitudinal, prospective studies that showed high sensitivity and specificity with ranges of 0.82- 0.99 and 0.90-1.00, respectively. Univariate measures of accuracy revealed a positive and negative likelihood ratio respectively of 3.61 (95% CI 1.56-5.67) and -2.35 (95% CI -3.79 to -0.91). By univariate approach, we found a pooled logarithm of diagnostic odds ratio of 6.15 (95% CI 2.64-9.67). A limitation of this analysis is that, although conducted in different settings (UK, Italy, France, South Africa, and Mauritius) and different clinical groups, they were based on a single academic group. According to our findings, IPG-P test showed very encouraging results as a rapid noninvasive screening test for preeclampsia. Further studies are needed to verify and to validate the reported findings.
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Affiliation(s)
- Marco Scioscia
- Department of Obstetrics and Gynecology, Policlinico Hospital, Abano Terme, Padua, Italy.
| | - Marco Noventa
- Department of Obstetrics and Gynecology, Policlinico Hospital, Abano Terme, Padua, Italy
| | | | - Gianluca Straface
- Department of Obstetrics and Gynecology, Policlinico Hospital, Abano Terme, Padua, Italy
| | - Giovanni Pontrelli
- Department of Obstetrics and Gynecology, Policlinico Hospital, Abano Terme, Padua, Italy
| | - Nicola Fattizzi
- Department of Obstetrics and Gynecology, Policlinico Hospital, Abano Terme, Padua, Italy
| | - Marco Libera
- Department of Obstetrics and Gynecology, Policlinico Hospital, Abano Terme, Padua, Italy
| | - Thomas W Rademacher
- Division of Infection and Immunity, University College London Medical School, London, United Kingdom, Middlesex University, London, United Kingdom
| | - Pierre-Yves Robillard
- Service de Réanimation Néonatale, Centre Hospitalier Universitaire Sud-Réunion, Saint-Pierre, France
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16
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Nagarajappa C, Rangappa SS, Suryanarayana R, Balakrishna S. Urinary protein carbonyl levels and its correlation with protein misfolding in preeclampsia. Hypertens Pregnancy 2019; 38:124-128. [PMID: 30913931 DOI: 10.1080/10641955.2019.1590720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the association of protein carbonylation with preeclampsia and its correlation with urinary protein misfolding. METHOD Protein carbonyl and misfolded protein levels were measured in the midstream urine sample (58 preeclamptic and 44 normotensive pregnancy) by ELISA and Congo Red Dot assay respectively. RESULTS Significant difference was observed in the levels of protein carbonyls (P = 0.002) and misfolded proteins (P = 0.001). Correlation between protein carbonyl and misfolded proteins levels was significant but weak (r = 0.3; P = 0.018). CONCLUSION Urinary protein carbonyl level is elevated in preeclampsia but plays a minor role in proteins misfolding.
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Affiliation(s)
- Chandrakala Nagarajappa
- a Department of Cell Biology and Molecular Genetics , Sri Devaraj Urs Academy of Higher Education and Research , Kolar , India
| | | | | | - Sharath Balakrishna
- a Department of Cell Biology and Molecular Genetics , Sri Devaraj Urs Academy of Higher Education and Research , Kolar , India
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17
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Rood KM, Buhimschi CS, Dible T, Webster S, Zhao G, Samuels P, Buhimschi IA. Congo Red Dot Paper Test for Antenatal Triage and Rapid Identification of Preeclampsia. EClinicalMedicine 2019; 8:47-56. [PMID: 31193633 PMCID: PMC6537515 DOI: 10.1016/j.eclinm.2019.02.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 02/12/2019] [Accepted: 02/15/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Proteins in the urine of women with preeclampsia (PE) bind Congo Red dye (urine congophilia). We sought to determine the diagnostic performance of a paper-based point-of-care test detecting urine congophilia for rapid triage and diagnosis of PE. METHODS Prospective cohort study conducted in 346 consecutive pregnant women evaluated for PE in the Labour and Delivery triage unit at our institution. The Congo Red Dot (CRD) Paper Test (index test) was performed on fresh urine samples. The CRD Paper Test results were compared to an expert adjudicated diagnosis in each case. The accuracy of the CRD Paper Test was also compared to urine and serum analytes (placental growth factor and soluble fms-like tyrosine kinase-1) previously proposed as diagnostic aids for PE. FINDINGS During the first triage visit, 32% (112/346) of women received a clinical diagnosis of PE. Yet, 63% (217/346) were admitted for in-patient diagnostic work-up or delivery. The CRD Paper Test was positive in 25% (86/346) of the cases. Adjudication confirmed PE in 28% (96/346) of all cases. The CRD Paper Test outperformed measured serum and urine markers (80·2% sensitivity, 89·2% specificity, 92·1% negative predictive value, 86·7% accuracy). The pre-test, positive and negative post-test probabilities were 27·7%, 74·0%, and 8·0%, respectively. Of women who were discharged undelivered, 38% (133/346) had at least one additional triage visit and the interval between the last negative and first positive CRD Paper Test was 12 (interquartile range, [5-34]) days. INTERPRETATION The CRD Paper Test is a simple, non-invasive, "sample-in/answer-out" point-of-care clinical tool for rapid identification of PE. FUNDING Saving Lives at Birth Program and NICHD.
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Affiliation(s)
- Kara M. Rood
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH 43210, USA
- Corresponding author at: The Ohio State University, Department of Obstetrics and Gynecology, Columbus, OH 43215, USA.
| | - Catalin S. Buhimschi
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH 43210, USA
- Department of Obstetrics & Gynecology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, 60612, USA
| | - Theresa Dible
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Shaylyn Webster
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Guomao Zhao
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43215, USA
- Department of Obstetrics & Gynecology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, 60612, USA
| | - Philip Samuels
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Irina A. Buhimschi
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43215, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH 43215, USA
- Department of Obstetrics & Gynecology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, 60612, USA
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18
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Balakrishna S, Nagarajappa C, Rangappa S. Misfolding linked mutations of SERPINA1 gene are uncommon in preeclampsia. ARCHIVES OF MEDICINE AND HEALTH SCIENCES 2019. [DOI: 10.4103/amhs.amhs_79_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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