Evaluation of the proteinuria - Creatininuria ratio for the diagnostic confirmation of preeclampsia in congolese pregnant women

Abstract

Context: Preeclampsia is a multisystem endothelial disease characterized by hypertension of pregnancy and glomeruloendotheliosis resulting in significant proteinuria. These days, the weight determination of urinary proteins by 24-hour proteinuria (P24) remains the reference method for biologically confirming this condition. However, the completion of the exam appears to be very burdensome with a long waiting period for results. Hence the need to use a simple alternative method such as the proteinuria / creatininuria ratio (PCR). Aims: Improve the diagnosis and management of preeclampsia by using a simple, less restrictive but reliable diagnostic method. Methodology: The study compared the results obtained from P24 versus PCR in confirming the diagnosis of preeclampsia in 149 Congolese women in whom the disease was suspected thanks to the urine dipstick. The cut-off values used for the diagnosis of preeclampsia were, for P24, a proteinuria> 300 mg / 24 h and for PCR a value> 30 mg / mmol. Results: Of the 149 pregnant women in whom the diagnosis of preeclampsia was suspected using the urine dipstick, only 85.9% had a P24> 300 mg. This diagnostic confirmation rate was similar to that obtained with PCR (86.6%). A linear correlation was found between P24 and PCR in the quantification of proteinuria and in the diagnosis of preeclampsia (r² = 0.627, p <0.004). Comparing the pathological values diagnosed by the two methods, the agreement was 89.1% (kappa = 0.767). The PCR showed an excellent predictive performance of maternal-fetal complications at the optimal threshold of 30.8 mg / mmol corresponding to a sensitivity of 96.6% and a specificity of 95% (Youden index 0.866). This threshold was 323 mg / 24h corresponding to a sensitivity of 84% and a specificity of 61.9% (Youden index 0.459) for P24. Conclusion: PCR seems to be a good alternative to P24 in confirming the diagnosis of preeclampsia in the settings most affected by this pathology