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

Thangaratinam, Shakila and Coomarasamy, Arri and O'Mahony, Fidelma and Sharp, Steve and Zamora, Javier and Khan, Khalid S and Ismail, Khaled MK (2009) Estimation of proteinuria as a predictor of complications of pre-eclampsia: a systematic review. BMC Medicine, 7 (1). p. 10. ISSN 1741-7015

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URL of Published Version: http://dx.doi.org/10.1186/1741-7015-7-10

Identification Number/DOI: doi:10.1186/1741-7015-7-10

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.

Type of Work:Article
Date:2009 (Publication)
School/Faculty:Colleges (2008 onwards) > College of Medical & Dental Sciences
Department:Academic Unit of Obstetrics and Gynaecology
Subjects:RG Gynecology and obstetrics
Institution:University of Birmingham
Copyright Holders:BioMed Central
ID Code:616
Refereed:YES
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