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The Urinary Protein-to-Creatinine Ratio in Canadian Women at Risk of Preeclampsia: Does the Time of Day of Testing Matter?
journal contribution
posted on 2023-05-26, 05:29 authored by Tony LaMontagneTony LaMontagne, Anne-Marie Cote, Evelyne ReyOBJECTIVES: To determine the performance of a protein-to-creatinine ratio threshold of 30 mg/mmol in pregnant women investigated for hypertension according to the time of day of the sample. METHODS: This prospective study included ambulatory pregnant women investigated for hypertensive disorders. A single voided random urine specimen was obtained to determine the protein-to-creatinine ratio, followed immediately by a 24-hour urine collection. Statistical analyses included Spearman correlation, sensitivity, specificity, predictive values, likelihood ratios, and receiver-operator characteristic curves with 95% confidence intervals. A P value < 0.05 was considered statistically significant. RESULTS: Among the 91 specimens analyzed, 47.3% showed significant proteinuria in the 24-hour collection and 33% were first morning samples. The protein-to-creatinine ratio and 24-hour urinary protein excretion were highly correlated (r = 0.92, P < 0.001). The diagnostic accuracy of the protein-to-creatinine ratio threshold of 30 mg/mmol was lower in first morning samples than in samples obtained during the rest of the day, with sensitivity 58% and 90%, specificity 93% and 100%, positive predictive value 88% and 100%, negative predictive value 72% and 92%, positive likelihood ratio 8 and not calculable, and negative likelihood ratio 0.45 and 0.1, respectively. The receiver-operator characteristic area under the curve was 0.94 (95% CI 0.86 to 1) for first morning samples and 1.0 (95% CI 0.99 to 1) for other samples. CONCLUSION: A protein-to-creatinine ratio threshold of 30 mg/mmol reliably identifies significant proteinuria, but its reliability is reduced in first morning samples. Consequently, such samples should not be used for this purpose.
History
Journal
JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADAVolume
36Pagination
303-308Location
NetherlandsPublisher DOI
ISSN
1701-2163Language
EnglishIssue
4Publisher
ELSEVIER INCUsage metrics
Keywords
Science & TechnologyLife Sciences & BiomedicineObstetrics & GynecologyPregnancyhypertensionproteinuradiagnosisprotein/creatinine ratioPROTEIN/CREATININE RATIOHYPERTENSIVE DISORDERSPREGNANCYDIAGNOSISEXCRETIONACCURACYSAMPLESpregnancyproteinuriaAdultCreatinineFemaleHumansLikelihood FunctionsPre-EclampsiaProspective StudiesProteinuriaROC CurveTime FactorsClinical Research4.2 Evaluation of markers and technologies4 Detection, screening and diagnosisPaediatrics and Reproductive Medicine not elsewhere classified
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