Estimation of proteinuria as a predictor of complications of pre-eclampsia: a systematic review

BMC Medicine

Khaled MK Ismail³  Khalid S Khan²  Javier Zamora¹  Steve Sharp⁴  Fidelma O'Mahony³  Arri Coomarasamy²  Shakila Thangaratinam² 

[1] Clinical Biostatistics Unit, Hospital Ramón y Cajal, Department of Biomathematics, University Complutense of Madrid, Madrid, Spain;Academic Unit of Obstetrics and Gynaecology, Birmingham Women's Hospital, Birmingham, B15 2TG, UK;Academic Unit of Obstetrics and Gynaecology, Keele University School of Medicine, University Hospital of North Staffordshire, Stoke-on-Trent, UK;NLH Specialist Library for ENT and Audiology, John Radcliffe Hospital, Oxford, UK

Others  :  1129099
DOI  :  10.1186/1741-7015-7-10

 received in 2008-09-24, accepted in 2009-03-24,  发布年份 2009

【 摘 要 】

Background

Proteinuria is one of the essential criteria for the clinical diagnosis of pre-eclampsia. Increasing levels of proteinuria is considered to be associated with adverse maternal and fetal outcomes. We aim to determine the accuracy with which the amount of proteinuria predicts maternal and fetal complications in women with pre-eclampsia by systematic quantitative review of test accuracy studies.

Methods

We conducted electronic searches in MEDLINE (1951 to 2007), EMBASE (1980 to 2007), the Cochrane Library (2007) and the MEDION database to identify relevant articles and hand-search of selected specialist journals and reference lists of articles. There were no language restrictions for any of these searches. Two reviewers independently selected those articles in which the accuracy of proteinuria estimate was evaluated to predict maternal and fetal complications of pre-eclampsia. Data were extracted on study characteristics, quality and accuracy to construct 2 × 2 tables with maternal and fetal complications as reference standards.

Results

Sixteen primary articles with a total of 6749 women met the selection criteria with levels of proteinuria estimated by urine dipstick, 24-hour urine proteinuria or urine protein:creatinine ratio as a predictor of complications of pre-eclampsia. All 10 studies predicting maternal outcomes showed that proteinuria is a poor predictor of maternal complications in women with pre-eclampsia. Seventeen studies used laboratory analysis and eight studies bedside analysis to assess the accuracy of proteinuria in predicting fetal and neonatal complications. Summary likelihood ratios of positive and negative tests for the threshold level of 5 g/24 h were 2.0 (95% CI 1.5, 2.7) and 0.53 (95% CI 0.27, 1) for stillbirths, 1.5 (95% CI 0.94, 2.4) and 0.73 (95% CI 0.39, 1.4) for neonatal deaths and 1.5 (95% 1, 2) and 0.78 (95% 0.64, 0.95) for Neonatal Intensive Care Unit admission.

Conclusion

Measure of proteinuria is a poor predictor of either maternal or fetal complications in women with pre-eclampsia.

【 授权许可】

   
2009 Thangaratinam et al; licensee BioMed Central Ltd.

【 图 表 】

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