SPOT URINE PROTEIN/CREATININE RATIO VERSUS 24 HOUR URINARY PROTEIN IN PREDICTING ADVERSE PREGNANCY OUTCOME IN PRE- ECLAMPSIA
Background: Urinalysis for proteins is one of the important fundamental investigations performed to diagnose preeclampsia, monitor the severity of the disease and help predict adverse pregnancy outcomes. Although the 24 hour protein quantification is the gold standard, it is time consuming, cumbersome to perform and urine collection occasionally can be incomplete. Recently, spot urine protein/creatinine ratio has been used to quantify urinary protein, with value comparable with the 24 hour urine estimation. Estimation of the ratio of spot urine protein to creatinine that best predicts maternal and fetal complications will aid in clinical management.
Objective: This study was designed to evaluate the correlation of spot urine protein to creatinine ratio (SUPCR) with 24 hour urine estimation and the relationship with adverse pregnancy outcomes in preeclamptics.
Method: This was a prospective cross sectional study to determine the place of admission spot urine protein creatinine ratio and admission 24 hour urinary protein values in predicting adverse pregnancy outcome in pregnant women with preeclampsia at the Federal Teaching Hospital Abakaliki (FETHA). Data analysis was done using IBM-SPSS software (version 20, Chicago II, USA).
Results: There was a strong positive correlation between the spot protein to creatinine ratio and 24-hour urine protein excretion (Pearson’s correlation coefficient r= 0.78; P < 0.001). The optimal spot protein/creatinine ratio cutoff point was 0.28 forurine protein excretion of ≥300 mg/24 h, with a sensitivity of 93.1% and a specificity of87.6%; while the optimal SUPCR cutoff point for urine excretion ≥5000mg/24 hour was3.92 with a sensitivity of 97.1% and a specificity of 90.4%. Women with proteinuria
<5000mg/ 24 hours or a SUPCR <3.9 were less likely to have neonates with APGAR
score <7 at the 1st minute of life. The risk of stillbirth was also significantly increasedwith massive 24 hour protein ≥5000mg or a PUPCR ≥3.9. Other maternal andneonatal outcomes assessed were not significantly related to the quantity of proteinuria.
Conclusion: There was a strong correlation between spot urine protein to creatinine ratio and 24 hour protein estimation. Heavy proteinuria was associated with an increased risk of stillbirth and APGAR score less than 7 in the 1st minute of life. Maternal and other neonatal outcomes assessed were not associated with the level of proteinuria.