Acurácia diagnóstica da razão proteinúria/creatininúria em pacientes com suspeita de síndrome de pré-eclâmpsia : revisão sistemática e metanálise de estudos diagnósticos

Abstract

Background: The laboratory gold standard test for identification of proteinuria in pregnant women is its measurement in a 24-hour urine sample. Urine protein-to-creatinine ratio in an isolated sample has been suggested as an option to a 24-hour urine collection. Proteinuria is a key feature of the preeclampsia syndrome. The current study aims at estimating the diagnostic accuracy of urine protein-to-creatinine ratio in comparison to 24 hours proteinuria determination in women with suspected preeclampsia syndrome. Methods: Systematic review and meta-analysis was used in comparing the accuracy of the protein-to-creatinine ratio in isolated urine samples with 24-hour urine protein excretion from Medline and LILACS electronic databases (to Feb/10) as data source. Results: The review included 14 studies with a total of 2,255 patients. Inclusion of a LILACS database search added one new paper to the sample. All the studies but two were cross-sectional in design. The method of urinary protein excretion evaluation differed among studies and was not mentioned in three. All the studies demonstrated significant correlation between protein-to-creatinine ratio and 24-hour proteinuria, with a coefficient greater than 0.500. Proteinuria-to-creatininuria ratio combined sensibility and specificity estimates were 86.6% (95% CI: 84.3-88.6) and 90.1% (95% CI: 88.2-91.7), respectively. Conclusion: The pooled estimate suggests that protein-to-creatinine ratio in isolated urine samples may be used for diagnosis and follow-up of patients with suspected preeclampsia syndrome.