Abstract
Abstract
Hypertensive disorders in pregnancy are the leading causes of maternal and fetal morbidity & mortality. Preeclampsia accounts for most of the hypertensive disorders. Quantification of proteinuria is important for making diagnosis and treatment. As the 24 hour urine protein estimation is time consuming and cumbersome, spot urinary protein creatinine ratio had been studied as an alternative method.
Objectives: 1. To assess the accuracy of a single spot urinary Protein creatinine ratio (PCR) in proteinuria quantification over 24 hour proteinuria and to assess whether a single spot urinary PCR can be used as a replacement for 24 hour urine protein measurement. 2. To determine the best cut off value of spot PCR for significant proteinuria. 3. To find timing of PCR that correlates well with 24 hour urine protein estimation.
Methodology: Prospective study was conducted at the department of obstetrics and gynaecology, Government medical college, Kozhikode, from April 2014 to May 2015. Three hundred antenatal women of >28 weeks gestation who were admitted with hypertension complicating pregnancy were included in the study. All the women were advised to collect urine for 24 hour period. Three spot samples of urine were collected following 24 hour collection by noon, night and next day morning. Correlation between PCR and 24 hour urine protein excretion was assessed by Pearson Correlation Coefficient. Receiver Operator Characteristic Curve ROC) analysis was used to find the best cut off value of PCR for predicting significant proteinuria and to know the best time for doing PCR.
Results: The PCR value correlated well with 24 hour urine protein estimation, with the correlation coefficient r=0.69(morning PCR),0.76(noon),0.71(night).ROC analysis showed the area under the curve(AUC) for PCR (morning, noon, night) to be 0.79, 0.95, 0.9 respectively with maximum being noon and the optimal cut off for predicting significant proteinuria at morning, noon, and night to be 0.47, 0.40 and 0.45, with sensitivity and specificity values of 89% and 91% with PCR at noon.
Conclusion: The present study showed good correlation between PCR and 24 hour urine protein. So PCR can be used as an alternative to 24 hour urine protein. The best cut off value of PCR for estimating significant proteinuria was 0.4 with sensitivity of 89% and specificity of 91% showing PCR measurement at noon to be taken as best timing of performing PCR.