Diagnostic accuracy of spot albumin creatinine ratio and its association with neonatal and maternal outcome in preeclampsia: Prospective analysis at a rural tertiary care centre

Abstract

Spot urinary ACR detection of proteinuria has been recommended to screen pre-eclampsia during pregnancy. Objective: Assessment of diagnostic accuracy of spot ACR and its association with neonatal and maternal outcome in preeclampsia.Methods: Eighty pregnant women who reported to the antenatal OPD at 17-20 weeks of period of gestation were enrolled in the study over the period of one year from Jan 2018 to Dec 2018 at Department of Obstetrics & Gynaecology Dr Rajendra Prasad Govt. Medical College, Kangra at Tanda, Himachal Pradesh, India. Preeclampsia was defined as per NHBPEP2000 working group, resting hypertension >140/90 mmHg after 20th weeks of pregnancy.Results: Prevalence of pre-eclampsia was 10%. Women with pre-eclampsia were significantly older than normotensive women (P=0.014). Incidence of pedal edema and abdominal edema was significant higher in the women with pre-eclampsia (P<0.05). 75% of pre-eclampsia women delivered neonates with low birth weight (P=0.044). Spot ACR was significantly higher in the women with pre-eclampsia in comparison to normotensive women (0.4 [0.22, 2.1] vs. 0.12 [0.1, 0.3]; P=0.003). Cut-off of spot ACR (>0.3), sensitivity and specificity were 62.5% and 79.2% while positive predictive value and negative predictive value were 25% and 90%. Diagnostic accuracy of spot ACR for detection of pre-eclampsia was 77.5%.Conclusion: ACR could be very useful test for predicting the development of preeclampsia, maternal as well as neonatal outcomes.