Association Between 24-Hour Proteinuria Value And Adverse Pregnancy Outcome In Preeclampsia Women

Objective:To discuss the diagnostic value of 24-hour proteinuria value and the impact of proteinuria on pregnancy outcome in women with pregnancy-induced hypertensive disorders. And on the basis, futher seeking the 24-hour proteinuria cut-off value for diagnosis of severe preeclampsia.Method:Complete clinical data of 65 cases with hypertensive disorders complicationg pregnancy(non-chronic hypertensive disorder pregnancies), from December 2012 to October 2013 were collected. Adverse pregnancy outcome was defined when at least one severe complication happened to mother and/or fetus. The data of qualitative research on association with the latest published diagnostic criteria for preeclampsia(PE)by American College of Obstetricians and Gynecologists(ACOG) and adverse pregnancy outcome were analyzed with SPSS13.0. Then complete clinical data of 92 cases of preeclampsia women from April 2011 to June 2013 were analyzed, according to different severe preeclampsia criteria of proteinuria of domestic and overseas clinical guideline. The date of quantitative research on association with 24-hour proteinuria value and adverse outcome were analyzed with SPSS13.0. Finally, 55 cases of PE, from December 2012 to October 2013, were analyzed to prove whether the result of quantitative research was true.Results : 1.In the qualitative research of 65 patients with pregnancy-induced hypertension, the rate of adverse pregnancy outcome was 63.1%(41/65), while the rate of good outcome was 36.9%(14/65). There was significant difference in the incidence of adverse pregnancy outcomes between PE and gestational hypertension, diagnosed according to 24-hour proteinuria(P=0.000). 2. The correlation coefficient between adverse outcome and whether 24-hour proteinuria was more than 0.3g was 0.557. And it was moderate level with statistical significance. 3.24-hour proteinuria value was both related to hypertensive disorders complicationg pregnancy and PE patients, and logistic regression equations were obtained. 4. In the quantitative research, the incidence of 92 PE patients with adverse outcome was 54%(50/92), while those with good outcome was 46%(42/92).The composition of adverse outcomes was varied. The incidences of adverse outcome with different level of proteinuria were unequal, and there were significant differences in them(P < 0.05). 5. When 24-hour proteinuria value was 1 g, it got the highest Youden index with 0.55, relatively high sensitivity and specific degrees. The area of the ROC curve corresponding to the maximum is 0.777. 6. When the 24 hours proteinuria value was 3 g, it got the highest positive predictive value with 90.32%, positive likelihood ratio corresponding to the highest level of 7.84. 7. In the validation research of 55 PE patients, the composition of those with mild proteinuria was 30, while 25 patients with severe proteinuria. In 30 mild proteinuria patients, the proportion of adverse outcome was 56.7%(17/30), while that of good result was 43.3%(13/30). 25 cases of severe proteinuria patients, the proportion of adverse pregnancy outcome was 96%(24/25), and that of good result was 4%(1/25). 8.When the 24 h urine protein cut-off value was 3 g, the corresponding sensitivity was 58.5% with that specificity was 92.9%, and the accuracy was 67.2%. The positive predictive value was 0.960, and corresponding negative predictive value was 0.433. The positive likelihood ratio was 12.949, with that negative likelihood ratio was 0.447, and that diagnostic odds ratio was 18.353. The area under the ROC curve was 0.807.Conclusions: 1.The criteria of ACOG guideline was not suitable for cases in this research, and 24-hour proteinuria value must be one of essential condition in diagnosis of PE. 2.24-hour proteinuria value was related to adverse outcome, considered as dependent criteria in severe PE diagnosis with high positive predictive value of adverse outcome. 3. It is suggested that the cutoff value of proteinuria with 3 g/24 h can act as one of criteria for severe preeclampsia. 4.When the 24-hour proteinuria value in PE patients was less than 3 g, blood pressure, liver and kidney function should be considered for further diagnosis and treatment.