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Madaan S, Jaiswal A, Acharya N, Tayade S, Dhok A, Kumar S, Acharya S, Dewani D, Talwar D, Halani D, Reddy Eleti M. Role of Salivary Uric Acid Versus Serum Uric Acid in Predicting Maternal Complications of Pre-Eclampsia in a Rural Hospital in Central India: A Two-Year, Cross-Sectional Study. Cureus 2022; 14:e23360. [PMID: 35475103 PMCID: PMC9020463 DOI: 10.7759/cureus.23360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 11/06/2022] Open
Abstract
Background Hypertensive disorders during pregnancy are an important topic of concern, specifically in rural and remote areas of India where there is a lack of awareness and it is difficult to maintain proper follow-up of pregnant females to screen them for complications developed during pregnancy. Gestational hypertension and pre-eclampsia result in the abruption of the placenta, hemolysis, elevated liver enzymes, low platelet count syndrome, eclampsia, and disseminated intravascular coagulation, which can be a serious threat to the health of the mother and the fetus. Therefore, it is important to identify biomarkers for diagnosing and predicting the complications of pre-eclampsia that may aid the obstetric high-dependency units based in rural areas to tackle this important health hazard during pregnancy. Methodology A total of 180 singleton pregnant women of more than 34 weeks of gestational age were enrolled in this study. All women were divided into three groups (control group, severe pre-eclampsia, and non-severe pre-eclampsia) based on the severity of blood pressure and the presence of proteinuria (≥+1 by the dipstick method). Salivary and serum uric acid levels were measured through morning samples, and all patients were monitored for the development of complications and outcomes. Salivary uric acid and serum uric acid levels were correlated with each other and with maternal complications of pre-eclampsia. Results Mean salivary uric acid (mg/dL) in severe pre-eclampsia was (6.72 ± 0.49) significantly higher compared to non-severe pre-eclampsia (4.75 ± 0.94) and control (3.13 ± 0.43). Mean serum uric acid (mg/dL) in severe pre-eclampsia was (8.13 ± 0.87) significantly higher compared to non-severe pre-eclampsia (6.23 ± 0.76) and control (3.85 ± 0.46).The lowest best cut-off value of maternal salivary uric acid was 5.06 mg/dL, above which one can predict maternal complications with a diagnostic accuracy of 78.33%. Conclusions Salivary uric acid and serum uric acid levels are significantly raised in cases of pre-eclampsia in comparison to normal pregnancy. Salivary uric acid and serum uric acid are correlated significantly indicating that salivary uric acid can function as a cost-effective, novel marker to provide an idea about serum uric acid levels. The prognostic accuracy of salivary uric acid was good in predicting maternal complications among cases of pre-eclampsia (severe and non-servere) and early-onset maternal complications. Therefore, it may be utilized as a helpful marker to identify high-risk patients.
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Chadha A, Tayade S. Urinary Protein-to-Creatinine Ratio: An Indicator of Adverse Clinical Outcomes in Preeclampsia With Proteinuria. Cureus 2022; 14:e23341. [PMID: 35464597 PMCID: PMC9017718 DOI: 10.7759/cureus.23341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background and objective Preeclampsia is a major contributor to morbidity and mortality among pregnant women and leads to poor fetomaternal outcomes. Predicting fetal and maternal health outcomes will enable early interventions so as to reduce further damage. Various biochemical tests like beta-human chorionic gonadotropin (β-HCG), inhibin A, activin A, pregnancy-associated plasma protein-A (PAPP-A), fetal DNA, and color Doppler have been studied for their ability to predict fetal and maternal health outcomes; however, most of these tests are complex and costly. Among the many variables that indicate the severity of outcomes in hypertensive disorders of pregnancy, the urinary protein-to-creatinine ratio (UPCR) is an important index. The aim of the study was to find out the association between UPCR and fetomaternal outcomes in preeclampsia. Material and methods A prospective observational study was conducted among 141 women with preeclampsia presenting with proteinuria, who were divided into two groups: 11% with UPCR <0.3 and 89% with UPCR ≥0.3. These patients were followed up till delivery to look for maternal and fetal outcomes. Results The sensitivity of UPCR for predicting adverse maternal outcomes was 79.37% (95% CI: 71.25-86.06), specificity was 46.67% (95% CI: 21.27-73.41), positive predictive value (PPV) was 92.59% (95% CI: 88.53-95.29), negative predictive value (NPV) was 21.21% (95% CI: 12.43-33.81), and the accuracy was 75.79% (95% CI: 67.97-82.69); for adverse fetal outcomes, the sensitivity was 76.98% (95% CI: 68.65-84.01), specificity was 13.33% (95% CI: 1.66-40.46), PPV was 88.18% (95% CI: 85.69-90.29), NPV was 6.45% (95% CI: 1.79-20.67), and the accuracy was 70.21% (95% CI: 61.94-77.62). Conclusion Based on our findings, UPCR is a simple laboratory tool that can help predict abnormal fetomaternal outcomes in preeclampsia with good sensitivity and PPV and can be used as an adjunct to assist in clinical decisions.
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Lei T, Qiu T, Liao W, Li K, Lai X, Huang H, Yuan R, Chen L. Proteinuria may be an indicator of adverse pregnancy outcomes in patients with preeclampsia: a retrospective study. Reprod Biol Endocrinol 2021; 19:71. [PMID: 33990220 PMCID: PMC8120921 DOI: 10.1186/s12958-021-00751-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/26/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Proteinuria is one of the common manifestations of patients with preeclampsia (PE), but whether the severity of proteinuria is related to the pregnancy outcome of patients with preeclampsia remains controversial. The present study aimed to determine the relationship between 24-h proteinuria and adverse outcomes in patients with preeclampsia. METHODS The present retrospective study included 329 pregnant women in Chongqing, China. Patients were divided into PE group and non-PE group. PE group was stratified into three subgroups based on the level of 24-h proteinuria. Correlation analysis was used to analyze the correlation between biochemical indexes and adverse pregnancy outcome, and Logistic regression analysis was used to analyze the risk factors of adverse pregnancy outcome. The receiver operating characteristic curve (ROC) was used to evaluate the ability of 24-h urinary protein to distinguish the adverse pregnancy outcome in patients with preeclampsia. RESULTS (1) Between PE and non-PE group, cesarean section rate in PE group was significantly higher than that in non-PE group (84.4% vs. 25.9%, p < 0.001). Laboratory findings such as uric acid and creatinine level in PE group were higher than those in non-PE group. (2) Among mild (proteinuria < 0.3 g/24 h), moderate (0.3 g/24 h ≦ proteinuria < 2 g/24 h) and massive (proteinuria ≧ 2 g/24 h) groups, the frequencies of induced labor (p = 0.006) and stillbirth (p = 0.002) increased with the increase of 24-h proteinuria. (3) Adverse outcomes were positively correlated with 24-h proteinuria (adverse maternal outcomes: r = 0.239, p = 0.002; adverse fetal outcomes: r = 0.336, p < 0.001). (4) The best 24-h proteinuria cutoff values to determine stillbirth, premature and fetal distress were 3965.0 mg/24 h, 984.75 mg/24 h and 1503.85 mg/24 h and their odds ratio (95% confidence interval) were 12.46 (3.46-44.88), 2.48 (1.15-5.37) and 10.02 (2.14-46.80), respectively. CONCLUSIONS The severity of 24-h proteinuia may forecast adverse outcomes in women with preeclampsia. We suggest proteinuria should be retained as one of the monitoring indexes in patients with preeclampsia. TRIAL REGISTRATION Retrospectively registered. (LTMCMTS202001).
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Affiliation(s)
- Tingting Lei
- First Clinical College, Chongqing Medical University, Chongqing, China
| | - Ting Qiu
- First Clinical College, Chongqing Medical University, Chongqing, China
| | - Wanyu Liao
- First Clinical College, Chongqing Medical University, Chongqing, China
| | - Kangjie Li
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Xinyue Lai
- First Clinical College, Chongqing Medical University, Chongqing, China
| | - Hongbo Huang
- Second Clinical College, Chongqing Medical University, Chongqing, China
| | - Rui Yuan
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing Univ-ersity Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, China
| | - Ling Chen
- The Center of Experimental Teaching Management, Chongqing Medical University, Chongqing, China.
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Sá CPND, Jiménez MF, Rosa MW, Arlindo EM, Ayub ACK, Cardoso RB, Kreitchmann R, El Beitune P. Evaluation of Angiogenic Factors (PlGF and sFlt-1) in Pre-eclampsia Diagnosis. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2020; 42:697-704. [PMID: 33254263 PMCID: PMC10309227 DOI: 10.1055/s-0040-1713916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE Recent observations support the hypothesis that an imbalance between angiogenic factors has a fundamental role in the pathogenesis of pre-eclampsia and is responsible for the clinical manifestations of the disease. The goal of the present study was to evaluate the sensitivity, specificity, and the best accuracy level of Soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), and sFlt-1/PlGF ratio in maternal serum and protein/creatinine ratio in urine sample to define the best cutoff point of these tests to discriminate between the patients with gestational hypertension and the patients with pre-eclampsia, to evaluate the possibility of using them as diagnostic methods. METHODS A prospective longitudinal study was performed, and blood samples were collected from 95 pregnant patients with hypertension to measure serum concentrations of biomarkers sFlt-1 and PlGF. Urine samples were collected for protein screening. Significance was set as p < 0.05. RESULTS The sFlt-1/PlGF ratio demonstrated a sensitivity of 57.5% and a specificity of 60% using 50.4 as a cutoff point. The test that showed the best accuracy in the diagnosis of pre-eclampsia was protein/creatinine ratio, with a sensitivity of 78.9% and a specificity of 70% using 0.4 as a cutoff point and showing an area under the receiver operating characteristic curve of 0.80 (p < 0.001). CONCLUSION No studied laboratory test proved to be fairly accurate for the diagnosis of pre-eclampsia, except for the protein/creatinine ratio. The evidence is insufficient to recommend biomarkers sFlt-1 and PlGF to be used for the diagnosis of pre-eclampsia.
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Affiliation(s)
- Catherine Primo Nogueira de Sá
- Department of Gynecology and Obstetrics, Universidade Federal de Ciências da Saúde, Porto Alegre, RS, Brazil.,Obstetrics Service, Santa Casa de Misericórdia, Porto Alegre, RS, Brazil.,Obstetrics Service, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Mirela Foresti Jiménez
- Department of Gynecology and Obstetrics, Universidade Federal de Ciências da Saúde, Porto Alegre, RS, Brazil.,Obstetrics Service, Santa Casa de Misericórdia, Porto Alegre, RS, Brazil
| | | | - Ellen Machado Arlindo
- Department of Gynecology and Obstetrics, Universidade Federal de Ciências da Saúde, Porto Alegre, RS, Brazil.,Obstetrics Service, Santa Casa de Misericórdia, Porto Alegre, RS, Brazil.,Obstetrics Service, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Antonio Celso Koehler Ayub
- Department of Gynecology and Obstetrics, Universidade Federal de Ciências da Saúde, Porto Alegre, RS, Brazil.,Obstetrics Service, Santa Casa de Misericórdia, Porto Alegre, RS, Brazil
| | - Rodrigo Bernardes Cardoso
- Department of Gynecology and Obstetrics, Universidade Federal de Ciências da Saúde, Porto Alegre, RS, Brazil.,Obstetrics Service, Santa Casa de Misericórdia, Porto Alegre, RS, Brazil
| | - Régis Kreitchmann
- Department of Gynecology and Obstetrics, Universidade Federal de Ciências da Saúde, Porto Alegre, RS, Brazil.,Obstetrics Service, Santa Casa de Misericórdia, Porto Alegre, RS, Brazil
| | - Patrícia El Beitune
- Department of Gynecology and Obstetrics, Universidade Federal de Ciências da Saúde, Porto Alegre, RS, Brazil.,Obstetrics Service, Santa Casa de Misericórdia, Porto Alegre, RS, Brazil
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Zhang N, Tan J, Yang H, Khalil RA. Comparative risks and predictors of preeclamptic pregnancy in the Eastern, Western and developing world. Biochem Pharmacol 2020; 182:114247. [PMID: 32986983 DOI: 10.1016/j.bcp.2020.114247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 11/15/2022]
Abstract
Preeclampsia (PE) is a complication of pregnancy characterized by hypertension (HTN-Preg), and often proteinuria. If not managed promptly, PE could lead to eclampsia and seizures. PE could also lead to intrauterine growth restriction (IUGR) and prematurity at birth. Although PE is a major cause of maternal and fetal morbidity and mortality, the underlying mechanisms are unclear. Also, there is a wide variability in the incidence of PE, ranging between 2 and 8% of pregnancies in the Eastern, Western and Developing world, suggesting regional differences in the risk factors and predictors of the pregnancy-related disorder. Several demographic, genetic, dietary and environmental factors, as well as maternal circulating biomarkers have been associated with PE. Demographic factors such as maternal race and ethnicity could play a role in PE. Specific genetic polymorphisms have been identified in PE. Maternal age, parity, education and socioeconomic status could be involved in PE. Dietary fat, protein, calcium and vitamins, body weight, and environmental factors including climate changes and air pollutants could also play a role in PE. Several circulating cytoactive factors including anti-angiogenic factors and cytokines have also been associated with PE. Traditional midwifery care is a common practice in local maternity care units, while advanced perinatal care and new diagnostic tools such as uterine artery Doppler velocimetry have been useful in predicting early PE in major medical centers. These PE risk factors, early predictors and diagnostic tools vary vastly in different regions of the Eastern, Western and Developing world. Further understanding of the differences in the demographic, genetic, dietary and environmental factors among pregnant women in different world regions should help in designing a region-specific cluster of risk factors and predictors of PE, and in turn provide better guidance for region-specific tools for early detection and management of PE.
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Affiliation(s)
- Ning Zhang
- Vascular Surgery Research Laboratories, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jing Tan
- Vascular Surgery Research Laboratories, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - HaiFeng Yang
- Vascular Surgery Research Laboratories, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Raouf A Khalil
- Vascular Surgery Research Laboratories, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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Villalain C, Herraiz I, Cantero B, Quezada S, Lopez A, Simón E, Galindo A. Angiogenesis biomarkers for the prediction of severe adverse outcomes in late-preterm preeclampsia. Pregnancy Hypertens 2020; 19:74-80. [PMID: 31927324 DOI: 10.1016/j.preghy.2019.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 11/05/2019] [Accepted: 12/08/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The optimal timing for delivery in non-severe late-preterm (34 + 0-36 + 6 weeks) preeclampsia (PE) is uncertain. It is attempted to reach term pregnancy safely but current clinical and analytical parameters fail to determine which cases will develop severe features that require preterm delivery. We aim to establish if angiogenic biomarkers may identify cases that would benefit from earlier delivery. STUDY DESIGN Prospective case-control study of 96 women (n = 48 controls and n = 48 cases with PE) with maternal determinations of the sFlt-1/PlGF ratio between 34 + 0 and 36 + 6 weeks. The PE group was classified in two groups based on the need (n = 26) or not (n = 22) for preterm delivery due to criteria of severity. Diagnostic accuracy of these biomarkers for predicting preterm delivery for severe PE was evaluated. MAIN OUTCOME MEASURES Women with PE showed higher median sFlt-1/PlGF ratio than controls (122 vs 5, p < 0.01) and lower PlGF MoM (0.7 vs 1.0, p < 0.01). However, these differences did not remain when both PE subgroups were compared. Diagnostic performance of the sFlt-1/PlGF ratio and PlGF at different cut-offs was poor for detecting PE requiring delivery before term. CONCLUSIONS Angiogenic biomarkers are not useful to predict which late-preterm PE cases will develop severe features that require preterm delivery.
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Affiliation(s)
- Cecilia Villalain
- Fetal Medicine Unit-SAMID, Department of Obstetrics and Gynaecology, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (imas12), Universidad Complutense de Madrid, Madrid, Spain
| | - Ignacio Herraiz
- Fetal Medicine Unit-SAMID, Department of Obstetrics and Gynaecology, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (imas12), Universidad Complutense de Madrid, Madrid, Spain.
| | - Borja Cantero
- Fetal Medicine Unit-SAMID, Department of Obstetrics and Gynaecology, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (imas12), Universidad Complutense de Madrid, Madrid, Spain
| | - Soledad Quezada
- Fetal Medicine Unit-SAMID, Department of Obstetrics and Gynaecology, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (imas12), Universidad Complutense de Madrid, Madrid, Spain
| | - Ana Lopez
- Department of Clinical Biochemistry, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital 12 de Octubre (imas12), Universidad Complutense de Madrid, Madrid, Spain
| | - Elisa Simón
- Fetal Medicine Unit-SAMID, Department of Obstetrics and Gynaecology, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (imas12), Universidad Complutense de Madrid, Madrid, Spain
| | - Alberto Galindo
- Fetal Medicine Unit-SAMID, Department of Obstetrics and Gynaecology, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (imas12), Universidad Complutense de Madrid, Madrid, Spain
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Bae EH, Kim JW, Choi HS, Ma SK, Kim SW. Impact of random urine proteinuria on maternal and fetal outcomes of pregnancy: a retrospective case-control study. Korean J Intern Med 2017; 32:1062-1068. [PMID: 27733023 PMCID: PMC5668390 DOI: 10.3904/kjim.2016.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 04/25/2016] [Accepted: 05/06/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Proteinuria is associated with hypertension and preeclampsia in pregnancy. However, the impact of random urine proteinuria on fetal and maternal outcomes has not been established. We investigated the influence of random urine proteinuria on the clinical outcomes of pregnancy. METHODS From January 2008 to December 2010, 2,822 patients were retrospectively studied. A total of 536 pregnant women with proteinuria in random urine and matched controls without proteinuria via propensity score matching were analyzed. Proteinuria was checked by the dipstick method. RESULTS The patients' mean age was 33.0 ± 4.7 years, and the mean gestational age was 235.6 ± 50.6 days on admission. The prevalence of hypertension and chronic kidney disease was 2.4% (n = 67) and 1.0% (n = 29), respectively. Women with random urine proteinuria showed higher blood urea nitrogen levels and a higher incidence of hematuria. These women also had a higher incidence of preeclampsia, preterm labor, premature rupture of membranes, and intrauterine growth restriction. Proteinuria was strongly correlated with preeclampsia in both propensity score matching (p < 0.001, r = 0.783) and unmatched whole samples (p < 0.001, r = 0.851). CONCLUSIONS These findings suggest that random urine proteinuria is associated with preeclampsia, preterm labor, premature rupture of membrane, and intrauterine growth restriction.
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Affiliation(s)
- Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Jong Woon Kim
- Department of Obsterics, Chonnam National University Medical School, Gwangju, Korea
| | - Hong Sang Choi
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
- Correspondence to Soo Wan Kim, M.D. Department of Internal Medicine, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju 61469, Korea Tel: +82-62-220-6271 Fax: +82-62-225-8578 E-mail:
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