Boya Li1, Li Lin1, Huixia Yang1, Yuchun Zhu1, Yumei Wei1, Xiaotian Li2, Dunjin Chen3, Xianlan Zhao4, Shihong Cui5, Hongjuan Ding6, Guifeng Ding7, Haixia Meng8, Hongwei Wei9, Xiaotong Sun10, Hong Xin11. 1. a Department of Obstetrics and Gynecology , Peking University First Hospital , Beijing , China. 2. b Department of Obstetrics and Gynecology , Obstetrics and Gynecology Hospital of Fudan University , Shanghai , China. 3. c Department of Obstetrics and Gynecology , The Third affiliated Hospital of Guangzhou Medical University , Guangzhou , China. 4. d Department of Obstetrics and Gynecology , The First Affiliated Hospital of Zhengzhou University , Zhengzhou , China. 5. e Department of Obstetrics and Gynecology , The Third Affiliated Hospital of Zhengzhou University , Zhengzhou , China. 6. f Department of Obstetrics and Gynecology , Nanjing maternity and Child Health Care Hospital , Nanjing , China. 7. g Department of Obstetrics and Gynecology , Obstetrics and Gynecology Hospital of Urumqi Municipality , Urumqi Municipality , China. 8. h Department of Obstetrics and Gynecology , The Affiliated Hospital of Inner Mongolia Medical University, Hohhot , China. 9. i Department of Obstetrics and Gynecology , The Maternal and Child Health Hospital of the Guangxi Zhuang Autonomous Region , Nanning , China. 10. j Department of Obstetrics and Gynecology , Gansu Province Hospital , Lanzhou , China. 11. k Department of Obstetrics and Gynecology , The Second Hospital of Hebei Medical University , Shijiazhuang , China.
Abstract
BACKGROUND: To identify the 24-h proteinuria value with quantitative analysis and how it correlates with the severity of preeclampsia and subsequent adverse maternal outcomes in the Chinese population. STUDY DESIGN: Eleven hospitals in 10 provinces across China were chosen, in which 1,738 pregnant women complicated by hypertensive disorders of pregnancy (HDP) with the records of 24 h proteinuria were enrolled. They were allocated into four groups: patients with maximal quantified proteinuria < 0.3 g/24 h (Group 1, n = 328); patients with maximal quantified proteinuria ≥ 0.3 g/24 h and < 2.0 g/24 h (Group 2, n = 638); patients with maximal quantified proteinuria ≥ 2.0 g/24 h and < 5.0 g/24 h (Group 3, n = 353); and patients with maximal quantified proteinuria ≥ 5.0 g/24 h (Group 4, n = 419). Logistic regression analysis were conducted to assess the differences in maternal outcomes between different subgroups of 24-h proteinuria and to identify independent risk factors of adverse maternal outcomes in preeclampsia. The multivariable risk prediction model of adverse maternal outcome for HDP was established with receiver operating characteristic curve (ROC) curve and its predicted value was assessed. RESULTS: Thrombocytopenia and cerebral or visual symptoms were more frequent in Groups 3 and 4 than Groups 1 and 2 but no differences were found between Groups 3 and 4 or Groups 1 and 2. Maternal complications were more frequent in Groups 3 and 4 than in Groups 1 and 2 [Group 3 vs. Group 1, odds ratios (ORs) = 3.359 (1.067-10.571); Group 4 vs. Group 1, OR = 3.628 (1.189-11.086); Group 3 vs. Group 2, OR = 2.845 (1.155-7.003); Group 4 vs. Group 2, OR = 3.082 (1.304-7.288)]. However, no significant difference was found between Groups 4 and 3 or between Groups 2 and 1. The proteinuria ≥ 2 g/24 h had an area under the receiver operating characteristic curve (AUC ROC) of 0.668 (95% confidence interval (CI) 0.632-0.705) for predicting adverse maternal outcome. After adjusting for the effects of other symptoms, signs, and laboratory tests, it was the independent risk factor and predictor factor of the adverse maternal outcome (OR = 3.683, 95% CI 2.439-5.562, P<0.001). The final risk prediction model had an AUC ROC of 0.800 (95% CI 0.769-0.830, P<0.001). CONCLUSION: The proteinuria ≥ 2 g/24 h is an independent predictive factor of adverse maternal outcomes in preeclampsia, but its individual predictive value is limited. The risk prediction model is effective in assessing the risk of adverse maternal outcomes in patients with HDP.
BACKGROUND: To identify the 24-h proteinuria value with quantitative analysis and how it correlates with the severity of preeclampsia and subsequent adverse maternal outcomes in the Chinese population. STUDY DESIGN: Eleven hospitals in 10 provinces across China were chosen, in which 1,738 pregnant women complicated by hypertensive disorders of pregnancy (HDP) with the records of 24 h proteinuria were enrolled. They were allocated into four groups: patients with maximal quantified proteinuria < 0.3 g/24 h (Group 1, n = 328); patients with maximal quantified proteinuria ≥ 0.3 g/24 h and < 2.0 g/24 h (Group 2, n = 638); patients with maximal quantified proteinuria ≥ 2.0 g/24 h and < 5.0 g/24 h (Group 3, n = 353); and patients with maximal quantified proteinuria ≥ 5.0 g/24 h (Group 4, n = 419). Logistic regression analysis were conducted to assess the differences in maternal outcomes between different subgroups of 24-h proteinuria and to identify independent risk factors of adverse maternal outcomes in preeclampsia. The multivariable risk prediction model of adverse maternal outcome for HDP was established with receiver operating characteristic curve (ROC) curve and its predicted value was assessed. RESULTS:Thrombocytopenia and cerebral or visual symptoms were more frequent in Groups 3 and 4 than Groups 1 and 2 but no differences were found between Groups 3 and 4 or Groups 1 and 2. Maternal complications were more frequent in Groups 3 and 4 than in Groups 1 and 2 [Group 3 vs. Group 1, odds ratios (ORs) = 3.359 (1.067-10.571); Group 4 vs. Group 1, OR = 3.628 (1.189-11.086); Group 3 vs. Group 2, OR = 2.845 (1.155-7.003); Group 4 vs. Group 2, OR = 3.082 (1.304-7.288)]. However, no significant difference was found between Groups 4 and 3 or between Groups 2 and 1. The proteinuria ≥ 2 g/24 h had an area under the receiver operating characteristic curve (AUC ROC) of 0.668 (95% confidence interval (CI) 0.632-0.705) for predicting adverse maternal outcome. After adjusting for the effects of other symptoms, signs, and laboratory tests, it was the independent risk factor and predictor factor of the adverse maternal outcome (OR = 3.683, 95% CI 2.439-5.562, P<0.001). The final risk prediction model had an AUC ROC of 0.800 (95% CI 0.769-0.830, P<0.001). CONCLUSION: The proteinuria ≥ 2 g/24 h is an independent predictive factor of adverse maternal outcomes in preeclampsia, but its individual predictive value is limited. The risk prediction model is effective in assessing the risk of adverse maternal outcomes in patients with HDP.
Entities:
Keywords:
HDP; Proteinuria; hypertensive disorders of pregnancy; maternal complications; preeclampsia; quantitative analysis of 24-h proteinuria