Evaluación del índice proteína-creatinina en orina aislada para la predicción de proteinuria significativa durante la gestación

Introduction

Diagnosis and follow-up of preeclampsia requires measurement of proteinuria and the gold standard for this evaluation is the 24-hour collection. However, this collection is cumbersome, time consuming and delays clinical diagnosis. The purpose of this study is assess the diagnostic performance of the spot urine protein/creatinine (P/C) ratio to predict the absence or presence of significant proteinuria (≥ 300 mg per 24 hours) among outpatient pregnant women with suspected or previous diagnosis of preeclampsia.

Material and methods

The P/C ratio was calculated in 106 single voided urine samples, obtained after the completion of the 24-hour collection, from 66 outpatient pregnant women admitted to the Maternal Fetal Care Unit at our Hospital to follow-up of hypertension gestational. Correlation between the spot urine P/C ratio with the 24-hour urine protein excretion was calculated. Receiver operator characteristic (ROC) curves analysis was used to evaluate the diagnostic performance and to determinate the best cutoff to predict the absence or presence of significant proteinuria.

Results

Significant proteinuria on 24 hour collection urine was identified in 31 urines from 22 pregnant women. There was a significant correlation between the spot urine P/C and 24-hour urine protein excretion (r_Spearman = 0,658, p = 0,01). ROC curves analysis revealed an area under the curve for spot P/C ratio of 0,838, greater than urine dipstick (0,629). No single P/C ratio cutoff was appropriate to rule-out or predict significant proteinuria; however, use of dipstick and spot urine P/C ratio, with two cutoffs, 120 mg/g to predict the absence of significant proteinuria and 240 mg/g to confirm it, clasiffied correctly 44,3% of urines and avoided the collection of 24 hours urine in 51% of the cases.

Conclusions

Spot urine P/C ratio, in conjunction with dipstick urianalysis, is a useful test in the initial screen for rule-out and predict significant proteinuria in outpatient pregnant women with hypertensive pregnancy or preeclampsia, but it should not be used as an alternative to 24-hour total protein evaluation in midrange P/C ratio, requiring a full 24-hour urine for accurate results.     

Accuracy of the spot urinary microalbumin:creatinine ratio and visual dipsticks in hypertensive pregnant women

Objectives

New developments in proteinuria assessment have included the use of spot urinary microalbumin to creatinine ratio measurements. This study determines the accuracy of spot urinary microalbumin to creatinine ratio dipsticks and conventional visual dipsticks compared to the 24 h urinary protein (gold standard) to detect significant proteinuria in hypertensive pregnant women.

Study design

163 women presenting with pregnancy hypertension were recruited from antenatal clinics. On admission each participant had a spot urine sample tested using a semi-quantitative visual dipstick and a spot midstream urine sample collected and analysed using the semi-quantitative urinary microalbumin to creatinine ratio dipsticks read instrumentally on the Clinitek^® 50 urine chemistry analyser. A 24 h urinary protein estimation was then performed. The results of the urinary microalbumin to creatinine ratio dipsticks and the conventional visual dipsticks were compared to the 24 h urine protein. A urinary microalbumin to creatinine ratio of ≥300 mg/g (1+ to 4+ on urine dipsticks) was considered a positive result ≥0.3 g/24 h was considered significant proteinuria.

Results

The visual dipstick had a sensitivity of 51% (95% CI [0.41–0.61]) and specificity of 91% (95% CI [0.81–0.96]). The PPV and NPV was 89% (95% CI [0.77–0.95]) and 58% (95% CI [0.48–0.67]), respectively. The urinary microalbumin to creatinine ratio dipsticks had a sensitivity of 63% (95% CI [0.52–0.72]) and specificity of 81% (95% CI [0.70–0.89]). The PPV was 82% (95% CI [0.71–0.90]) and NPV was 62% (95% CI [0.51–0.71]).

Conclusion

Neither the visual dipstick nor the urinary microalbumin to creatinine ratio dipstick read on the Clinitek^® 50 system is accurate when compared to the total 24 h urinary protein. Differences between the urinary microalbumin to creatinine ratio and 24 h total urinary protein may be due to the variation in the albumin fraction of the total urinary protein of pre-eclampsia, technical problems with imprecision of the assay technique, and clinical causes of false positives and negatives. The improved sensitivity of the automated urinary microalbumin to creatinine ratio dipstick over the visual dipstick suggests it may be a suitable substitute for the visual dipstick in clinical practice.     

Spot urine protein–creatinine ratio and 24-h urine protein excretion: Diagnostic accuracy in women with pre-eclampsia

ObjectiveTo compare the efficacy of spot urinary protein/creatinine ratio with 24 h urinary protein excretion in women with pre-eclampsia.MethodsA total of 85 women with hypertensive disorders during pregnancy were prospectively studied. Urine protein/creatinine ratio in spot urine sample was compared with 24 h urinary protein. Sensitivity and specificity for urinary spot P/C (protein/creatinine) ratio was assessed, and receiver operating curve was used to determine the value against the gold standard of >300 mg proteinuria in 24 h urinary sample.ResultsOf 85 women, complete data were available for 81 women. There was a strong correlation between spot urinary P/C ratio and 24 h urine protein excretion (r = 0.81, P value <0.000). The optimal spot P/C ratio cut-off point was 0.14 for 300 mg/24 h of protein excretion (preeclampsia) with a sensitivity of 82% and specificity of 79%.ConclusionWe found a strong correlation between spot urinary P/C and 24 h urinary protein. Spot urinary protein/creatinine ratio is a good predictor of proteinuria for pre-eclampsia.     

The value of the progesterone-to-estradiol ratio on the day of hCG administration in predicting ongoing pregnancy and live birth rates in normoresponders undergoing GnRH antagonist cycles

Objective

To investigate the relationship of the progesterone-to-estradiol (P/E₂) ratio on the day of hCG administration with ongoing pregnancy rates in patients with normal ovarian reserve undergoing GnRH antagonist cycles.

Study design

Observational cohort study including 129 women with normal ovarian reserve undergoing the GnRH antagonist protocol at the IVF unit of Ankara University School of Medicine. Receiver operating characteristics (ROC) analysis was performed to determine cut-off values for the P/E₂ ratio detrimental to IVF/ICSI-ET outcomes. The ongoing pregnancy rate was the primary outcome measure. Groups were compared using the independent-samples Student's t-test, Mann Whitney and Chi-Square tests. Multivariate logistic regression analysis was used to study the association between the variables and the P/E₂ ratio.

Results

The optimal cut-off value for P/E₂ ratio in GnRH antagonist cycles was 0.48; ongoing pregnancy rates and live birth rates were found to be significantly higher in patients with P/E₂ ratios ≤ 0.48 than those with > 0.48 (50% vs 22.4%, p = 0.001 and 38.5% vs 19.7%, p = 0.02, respectively). In logistic regression analysis, the P/E₂ ratio was found to be an independent predictor for pregnancy, but the sensitivity (69%), specificity (61%) and overall accuracy (67%) were low as a predictor test for cycle outcome.

Conclusion

Although a P/E₂ ratio ≤ 0.48 on the day of hCG administration was associated with significantly higher ongoing pregnancy and live birth rates, it has poor predictive value for cycle outcome in patients with normal ovarian reserve undergoing GnRH antagonist cycles.     

Dosing interval of 24 hours versus 48 hours between mifepristone and misoprostol administration for mid-trimester termination of pregnancy

Objective

To compare the efficacy of a shorter interval (24 hours) between misoprostol and mifepristone administration with that of the conventional dosing interval (48 hours) for second-trimester termination of pregnancy (TOP).

Methods

This was a prospective randomized, controlled, open-label study of 98 healthy women opting for mid-trimester TOP. The women were randomized to receive 200 mg mifepristone orally, followed 24 hours (Group 1) or 48 hours (Group 2) later by misoprostol (800 μg, then 400 μg every 3 hours). The primary outcome measure was the percentage of successful abortions within 24 hours. Secondary outcome measures were the induction-to-abortion interval (measured from misoprostol administration) and the frequencies of complications and adverse effects.

Results

The rate of successful abortions was similar with the 24-hour and 48-hour dosing intervals (95.8% and 93.6%, respectively; P = 0.38). The mean induction-to-abortion interval was also comparable between the 2 groups (8.6 ± 4.1 hours versus 8.7 ± 3.9 hours; P = 0.37). Nulliparous women and women with a pregnancy duration of 16 weeks or more had a longer induction-to-abortion interval in both groups.

Conclusion

The 24-hour dosing interval between misoprostol and mifepristone administration seems to be as effective as the 48-hour dosing interval for second trimester TOP.Clinical Trial Registry India: CTRI/2011/05/001770.     

Lecithin/sphingomyelin ratio and lamellar body count for fetal lung maturity: a meta-analysis

Objective

To determine and compare the diagnostic accuracy of the lecithin/sphingomyelin (L/S) ratio and lamellar body count (LBC) in the prediction of neonatal respiratory distress syndrome (RDS).

Study design

A systematic review was performed to identify studies comparing either the L/S ratio or the LBC with the occurrence of RDS published between January 1999 and February 2009. Two independent reviewers performed study selection and data extraction. For each study sensitivity and specificity were calculated. Summary receiver-operating characteristics (ROC) curves, assessing the diagnostic performance of both tests, were constructed. A subgroup analysis was performed to estimate the sensitivity and specificity of the various cut-off values.

Results

13 studies were included. The ROC curves of the collected data illustrate that the LBC and L/S ratio perform equally well in the prediction of RDS. Comparison of the two summary ROC curves of each test indicates that the diagnostic performance of LBC might even have a slight advantage over L/S ratio. Due to the wide cut-off range it was not possible to define specific cut-off values with the best accuracy.

Conclusion

We recommend replacing the L/S ratio as gold standard with the lamellar body count since the LBC is easy to perform, rapid, inexpensive, and available to all hospitals 24 h per day.     

Evaluation of Rapid Diagnostic Methods of Urinary Protein Estimation in Patients of Preeclampsia of Advanced Gestational Age

Background

24-h urine protein is traditionally used as a gold standard method for protein estimation. Because of the operational difficulty, there is the necessity to use rapid, convenient, and reliable method of proteinuria estimation.

Aim

We carried out this study to compare the two rapid methods of protein estimation: dipstick method and spot urine protein creatinine ratio (UPCR) with that of 24-h urine protein in patients of preeclampsia with advanced gestational period.

Methodology

The values of proteinuria estimated by dipstick method and spot UPCR were compared with that of 24-h urine protein. The strength of correlation was measured by Pearson’s correlation coefficient (r). A p value of <0.05 is considered to be statistically significant. The most discriminant spot UPCR value for detecting significant proteinuria (≥300 mg/day) was determined by plotting receiver–operator curve (ROC).

Result

The value of spot UPCR strongly correlated with 24-h urine protein (r = 0.88 with p value <0.001). The most discriminant spot UPCR value for detecting significant proteinuria (≥300 mg/day) was 0.3. The estimation of proteinuria by dipstick method was poorly correlated with 24-h urine protein with r = −0.09.

Conclusion

Spot UPCR can be used as a rapid and reliable alternative method in preference to 24-h proteinuria in patients of preeclampsia of advanced gestational age.     

Identification of patients with persistent trophoblastic disease after complete hydatidiform mole by using a normal 24-hour urine hCG regression curve

Objective

The aim of this study was to establish a reference 24-hour urine human chorionic gonadotropin (hCG) regression curve in patients with complete hydatidiform mole (CHM) as diagnostic tool in the prediction of persistent trophoblastic disease (PTD).

Methods

From 2004 to 2011, 312 cases suitable for this study were registered at the Hydatidiform Mole Registry of the Royal Women's Hospital Melbourne, Australia. hCG levels of 61 patients diagnosed as having PTD according to FIGO 2000 criteria were compared with the 95th-percentile (p95) of the normal regression curve derived from hCG levels of 251 cases of uneventful CHM.

Results

In the test group of 61 patients PTD was diagnosed by FIGO 2000 criteria after a mean (± SD, min.–max.) of 7.6 (± 3.4, 3.0–16.7) weeks after evacuation of the mole while in the same group hCG values for the first time exceeded the upper limit of the 95th percentile significantly earlier after 4.5 (± 1.9, 2.0–9.9) weeks (P < 0.001).However, hCG levels of 14% of the cases of uneventful CHM at least once exceeded the upper limit of p95, showing that one single value above p95 is not accurate enough for the diagnosis of PTD.

Conclusions

The normal 24-hour urine hCG regression curve may be used as a tool in the follow-up of an individual case of CHM after evacuation. At least one hCG level exceeding the upper limit of p95 within 11 weeks after evacuation could be added to the current FIGO criteria, in order to diagnose PTD early, but the lack of it may also prevent unnecessary treatment.     

Urinary spot albumin:creatinine ratio for documenting proteinuria in women with preeclampsia

Aim: To assess whether a single urinary spot urinary albumin:creatinine ratio (ACR) can be used to estimate 24-hour urinary protein excretion in women with preeclampsia. Methods: ACR and 24-hour urinary protein excretion were measured in 50 consecutive patients with preeclampsia. ACR was determined in a spot midstream urine sample and the amount of protein excretion was quantified in a 24-hour urine collection performed the following day. The correlation between the spot ACR and 24-hour urine protein excretion was assessed, and the diagnostic value of ACR was expressed in terms of specificity and sensitivity. Receiver operating characteristic curve analysis was used to determine the best cutoff values of the spot ACR for mild preeclampsia (proteinuria ≥ 0.3 g/24 h) and severe preeclampsia (defined in China as proteinuria ≥ 2 g/24 h). Results: A strong correlation was evident between the spot ACR and 24-hour urinary protein excretion (r = .938; P < .001). The optimal spot ACR cutoff point was 22.8 mg/mmol for 0.3 g/24 h of protein excretion (mild preeclampsia) with a sensitivity and specificity of 82.4% and 99.4%, respectively, and 155.6 mg/mmol for 2 g/24 h of protein excretion (severe preeclampsia) with a sensitivity and specificity of 90.6% and 99.6%, respectively. Conclusions: Compared with 24-hour urinary protein excretion, the spot urinary ACR may be a simple, convenient, and accurate indicator of significant proteinuria in women with preeclampsia.     

Urine albumin/creatinine ratio for the assessment of albuminuria in pregnancy hypertension

BACKGROUND: An accurate method to assess albuminuria in pregnancy is mandatory to diagnose pre-eclampsia. Twenty-four-hour urine collection is still the only universally accepted method. This is, however, a cumbersome and inconvenient method. Therefore, the present study aimed at assessing the accuracy of a spot urine albumin/creatinine ratio in pregnant women with hypertension. MATERIAL AND METHODS: In 54 pregnant women with blood pressure >or=140/90 mmHg, 24-h albumin excretion and subsequent albumin/creatinine ratio on morning spot urine were analyzed in the individual patients. Altogether 75 paired samples were included. Receiver operating characteristic curves, relating different albumin/creatinine ratio cut-off values to 24-h albumin excretion >300 mg were constructed. Correlations were assessed by Spearman rank correlation tests. RESULTS: The area under the receiver operating characteristic curve was 0.985. At the optimal cut-off albumin/creatinine ratio value of 27 mg/mmol the sensitivity, specificity, positive and negative predictive value for detecting albuminuria >300 mg/24 h were: 95, 100, 100 and 86% respectively. There was a close correlation between albumin/creatinine ratio and 24-h albumin excretion values (r=0.95; p<0.001). CONCLUSIONS: It is suggested that in most cases the more cumbersome 24-h urine collection can be replaced by the more convenient albumin/creatinine ratio on spot urine.     

Can preoperative neutrophil:lymphocyte and platelet:lymphocyte ratios be used as predictive markers for lymph node metastasis in squamous cell carcinoma of the vulva?

Objective

To determine whether the neutrophil:lymphocyte ratio (NLR) and platelet:lymphocyte ratio (PLR) before complete surgical staging provide information on lymph node metastasis in vulvar squamous cell carcinoma (SCC).

Study design

All patients with vulvar SCC who underwent complete surgical staging at two institutions between 1 January 2005 and 31 December 2011 were identified retrospectively from patient databases. Receiver operating characteristic (ROC) curve analysis was used to evaluate cut-off, sensitivity, and specificity values for preoperative NLR and PLR to predict lymph node metastasis.

Results

Data from 64 women with adequate information were analyzed. Lymph node involvement was detected in 19 (29.7%) patients. NLR and PLR were higher in the lymph node – positive group than in the – negative group (p < 0.001). The best cut-off values for predicting lymph node metastasis were 2.81 for the NLR, with 84.5% sensitivity and 89.5% specificity, and 139.5 for the PLR, with 68.9% sensitivity and 89.5% specificity. Forty of the 64 (62.5%) patients had NLRs ≤2.81 and 24 (37.5%) had NLRs >2.81. Lymph node involvement was more common in the NLR >2.81 group [60.7% vs. 5.6%; relative risk RR = 10.9, 95% confidence interval CI = 2.7–43.4; p < 0.001]. Mean tumor sizes were 4.2 ± 2.3 cm in the NLR >2.81 group and 2.1 ± 1.2 cm in the NLR ≤2.81 group (p = 0.001). The rate of lymph node involvement was higher in the PLR >139.5 group than in the PLR ≤ 139.5 group (54.8% vs. 6.1%; RR = 9.0, 95% CI = 2.2–35.9; p < 0.001).

Conclusion

Preoperative NLR and PLR are directly associated with nodal involvement status of vulvar SCC. These markers are simple, readily obtained and calculated, and easy to integrate into the surgical work-up of patients with vulvar SCC, at no extra cost.     

Prediction of clinical infection in women with preterm labour with intact membranes: A score based on ultrasonographic,clinical and biological markers

Objective

To predict maternal and neonatal clinical infection at admission in women hospitalized for preterm labour (PTL) with intact membranes.

Study design

Prospective study of 371 women hospitalized for preterm labour with intact membranes. The primary outcome was clinical infection, defined by clinical chorioamnionitis at delivery or early-onset neonatal infection.

Results

Clinical infection was identified in 21 cases (5.7%) and was associated with earlier gestational age at admission for PTL, elevated maternal C-reactive protein (CRP) and white blood cell count (WBC), shorter cervical length, and a cervical funnelling on ultrasound. We used ROC curves to determine the cut-off values that minimized the number of false positives and false negatives. The cut-off points chosen were 30 weeks for gestational age at admission, 25 mm for cervical length, 8 mg/l for CRP and 12,000 c/mm³ for WBC. Each of these variables was assigned a weight on the basis of the adjusted odds ratios in a clinical infection risk score (CIRS). We set a threshold corresponding to a specificity close to 90%, and calculated the positive and negative predictive values and likelihood ratios of each marker and of the CIRS. The CIRS had a sensitivity of 61.9%, while the sensitivity of the other markers ranged from 19.0% to 42.9%. Internal cross-validation was used to estimate the performance of the CIRS in new subjects. The diagnostic values found remained close to the initial values.

Conclusion

A clinical infection risk score built from data known at admission for preterm labour helps to identify women and newborns at high risk of clinical infection.     

Random urine protein-creatinine ratio to predict proteinuria in new-onset mild hypertension in late pregnancy

OBJECTIVE: The aim of this study was to evaluate the diagnostic accuracy of random urine protein-creatinine ratio for prediction of significant proteinuria (> or = 300 mg/24 h) in patients with new-onset mild hypertension in late pregnancy. METHODS: Medical records of 185 consecutive pregnant patients with new onset of mild hypertension in late pregnancy were reviewed. Random urine samples were taken before 24-hour urine collection. The predictive values of the random urine protein-creatinine ratio for diagnosis of significant proteinuria were estimated by using at least a 300-mg protein level within the collected 24-hour urine as the gold standard. RESULTS: Thirty-nine patients (21%) had significant proteinuria. There was a significant association between 24-hour protein excretion and the random urine protein-creatinine ratio (rs = 0.56, P <.01). With a cutoff protein-creatinine ratio greater than 0.19 as a predictor of significant proteinuria, sensitivity and specificity were 85% and 73%, respectively. Positive and negative predictive values of the test were 46% and 95%, respectively. CONCLUSION: The random urine protein-creatinine ratio was a poor predictor for significant proteinuria in patients with new-onset mild hypertension in late pregnancy.     

Examination of a first-trimester Down syndrome screening concept on a mix of 11,107 high- and low-risk patients at a private center for prenatal medicine in Germany

Objective

To assess the performance of a combined first-trimester screening concept for trisomies 21, 18 and 13 applied to a low- and high-risk patient sample in a specialized private center for prenatal medicine.

Study design

The quality of different first-trimester screening algorithms (risk calculation based on maternal age and nuchal translucency alone, maternal age and serum parameters (free β-hCG and PAPP-A) alone and a combination of both) was evaluated in a study population of low- and high-risk cases for fetal aneuploidies. All measurements were performed between the 11th + 0 and 13th + 6 weeks of gestation during the study period from November 2000 to December 2006, in accordance with the guidelines of the Fetal Medicine Foundation (FMF), London.

Results

Of 11,107 women included in the study, we had a complete follow-up on 10,668. The difference between the detection rate was insignificant for both the low-risk and the high-risk groups. In the overall study population, 52 of 59 cases of trisomy 21 were detected when a pre-defined cut-off of 1:300 was applied (detection rate (DR) 88.1%; 95% confidence interval (CI): 79.8–96.4 and false-positive rate (FPR) 4.9%; 95% CI: 4.5–5.3). For trisomies 13 and 18 with a pre-defined cut-off of 1:150, 26 of 32 cases were detected (DR 81.3%; 95% CI: 67.8–94.8 and FPR 0.7%; 95% CI: 0.5–0.9). The highest sensitivity was between 11 + 0 and 11 + 6 weeks of gestation with all cases of trisomy 21 detected with a FPR 5.1%; 95% CI: 3.7–6.5.

Conclusion

In our study population of different risk categories, the detection rate using the combined risk calculation based on maternal age, fetal NT, maternal PAPP-A and free β-hCG levels was superior to the application of either parameter alone.     

A prospective comparison of total protein/creatinine ratio versus 24-hour urine protein in women with suspected preeclampsia

OBJECTIVE: The purpose of this study was to determine the value of the protein/creatinine ratio in prediction of 24-hour urine total protein among women with suspected preeclampsia. STUDY DESIGN: Women who were evaluated for suspected preeclampsia at >or=24 weeks of gestation were studied prospectively if there was no concurrent diagnosis of chronic hypertension, diabetes mellitus, or preexisting renal disease. A protein/creatinine ratio was obtained, which was followed by the initiation of a 24-hour urine evaluation. Positive and negative predictive values and sensitivity and specificity of the protein/creatinine ratio for significant (>or=300 mg) and severe proteinuria (>or=5000 mg) that were based on 24-hour urine total protein were calculated. RESULTS: A total of 220 women were evaluated; 43.2% of the women were black, and 80% of the women had government insurance. Mean maternal and gestational ages were 26.1 years and 36.5 weeks, respectively. Significant and severe proteinuria on 24-hour urine evaluation were identified in 76.4% and 8.2% of cases, respectively. Regression analysis of protein/creatinine ratio and 24-hour urine total protein level showed a poor correlation (r(2)=0.41). Receiver operator characteristic analysis revealed an area under the curve of 0.80, but the shoulder value of 390 mg/g carried a high false-negative rate (45.2%). With a more conservative cutoff value, a protein/creatinine ratio of >or=300 mg/g had a poor negative predictive value (47.5%), a specificity for significant proteinuria (55.8%), with a positive predictive value of 85.5%, and a sensitivity of 81%. For severe proteinuria, a protein/creatinine ratio of >or=5000 mg/g had a poor positive predictive value (61.9%) and sensitivity (72.2%), with a negative predictive value of 97.5%, and a specificity of 96.0%. CONCLUSION: Protein/creatinine ratio does not exclude adequately the presence of significant proteinuria or predict severe proteinuria and should not be used as an alternative to 24-hour total protein evaluation.     

Experience of tubo-ovarian abscess in western Turkey

Objective

To investigate the clinical and laboratory parameters, treatments, and complications of patient with tubo-ovarian abscess (TOA).

Methods

Data for 296 patients diagnosed with TOA (clinically and sonographically) between January 2005 and December 2012 were retrospectively reviewed at 3 tertiary referral hospitals in Turkey. Patients were compared on the basis of TOA size, demographic characteristics, clinical and sonographic presentation, and laboratory findings.

Results

Seventy-six patients (25.7%) underwent surgery because antibiotic treatment was unsuccessful. The mean abscess size was larger and the mean C-reactive protein (CRP) level and the erythrocyte sedimentation rate (ESR) were higher among patients who required surgery. The ESR had a diagnostic value of 83.6%, and a specificity and sensitivity of 73.7% and 82.7%, respectively, for the need for surgical intervention, based on a cut-off value of 63.0 mm/hour. The CRP level had a diagnostic value of 80.4%, a specificity of 82.3%, and a sensitivity of 65.8% based on a cut-off value of 21.0 mg/L.

Conclusion

The combined use of the sonographic TOA diameter and laboratory parameters (ESR and CRP level) can aid clinical treatment decisions and improve the prediction of the outcome of medical TOA treatment.     

Prediction of persistent gestational trophobalstic neoplasia: the role of hCG level and ratio in 2 weeks after evacuation of complete mole

Objective

The aim of this study was to determine whether or not the serum human chorionic gonadotropin (hCG) level and ratio during 2 weeks after evacuation is predictive of persistent gestational trophoblastic neoplasia (GTN) in patients with complete molar pregnancies.

Methods

Between January 2000 and June 2010, a total of 467 patients with complete molar pregnancies were diagnosed. Seventeen patients, who had prophylactic chemotherapy and in whom insufficient data were available, were excluded. A receiver operating characteristic curve was used to determine the most useful predictive factor for persistent GTN and multivariate logistic regression was used for analyses.

Results

Persistent GTN was diagnosed in 109 of the 450 patients (24.2%) on the basis of the 2000 FIGO criteria. The optimal cut-off point for hCG 1 and 2 weeks after evacuation was 6400 mIU/mL (sensitivity, 54.1%; specificity, 65.1%) and 2400 mIU/mL (sensitivity, 64.2%; specificity, 78.3%), respectively. The optimal cut-off point for the ratio of pre-evacuation hCG to hCG 2 weeks after evacuation was 30 (sensitivity, 63.3%; specificity, 86.5%). Based on multivariate analysis, this ratio < 30 was an independent predictive factor for persistent GTN (odds ratio = 6.885; 95% confidence interval, 4.006-11.832; P < 0.001).

Conclusions

The decline ratio in hCG level 2 weeks after evacuation in patients with complete molar pregnancies is the most reliable predictor of persistent GTN. Our analysis may allow clinicians to stratify risk in patients with complete molar pregnancies and to provide more accurate counseling based on the hCG levels obtained 2 weeks after evacuation.     

A phase II study of gemcitabine,carboplatin and bevacizumab for the treatment of platinum-sensitive recurrent ovarian cancer

Purpose

The doublet gemcitabine and carboplatin is effective for the treatment of recurrent ovarian cancer, while multi-agent chemotherapy with bevacizumab may add additional benefit. This phase II study tested the efficacy and safety of a biweekly gemcitabine, carboplatin, and bevacizumab combination in patients with platinum-sensitive recurrent ovarian, peritoneal, or tubal cancer (ROC).

Patients and methods

Eligible patients received concurrent gemcitabine 1000 mg/m², carboplatin area under the curve 3, and bevacizumab 10 mg/kg administered intravenously on days 1 and 15 every 28 days for six cycles or up to 24 cycles if clinical benefit occurred. The primary end points were progression-free survival (PFS) by RECIST, and safety; the secondary end points were objective response rates and overall survival.

Results

Overall, 45 patients were enrolled. The median PFS was 13.3 months (95% CI, 11.3 to 15.3). The objective response rate was 69%. Grade 4 hematologic toxicities included neutropenia (27%) and thrombocytopenia (2%). Grades 3 and 4 non-hematologic toxicities included fatigue (18%), pain (9%), and nausea/vomiting (4%). There were 2 episodes of cerebrovascular accidents, 2 noted DVTs, and no episodes of bowel perforation. Median OS was 36.1 months (95% CI, 26.7 to 45.5).

Conclusion

Biweekly gemcitabine, carboplatin, and bevacizumab were an effective regimen in recurrent ovarian cancer, with comparable toxicity to recently reported day 1 gemcitabine, carboplatin, bevacizumab, and day 8 gemcitabine. Response rate and PFS are improved from reported outcomes of the gemcitabine carboplatin doublet. The degree to which biweekly dosing may present a more rationale schedule for this triplet should be evaluated further.     

Proteína C reactiva y homocisteína en menopáusicas tratadas con tibolona

Objective

To determine modifications in C-reactive protein and homocysteine in postmenopausal women who used tibolone.

Materials and methods

We selected a sample of 45 postmenopausal women treated with a 2.5-mg dose of tibolone daily for 6 months. Serum concentrations of C-reactive protein and homocysteine were measured.

Results

C-reactive protein concentrations were significantly increased after 6 months of treatment (0.51 ± 0.29 mg/dl at baseline compared with 0.95 ± 0.34 mg/dl after treatment; P<.05). Homocysteine concentrations were significantly reduced after 6 months of treatment (10.16 ± 1.45 picomol/L) compared with initial values (10.95 ± 1.87 picomol/L; P<.05).

Conclusions

After 6 months of use, tibolone significantly increased C-reactive protein concentrations and reduced homocysteine concentrations.     

Use of a random urinary protein-to-creatinine ratio for the diagnosis of significant proteinuria during pregnancy

OBJECTIVE: The purpose of this study was to evaluate whether a random urinary protein-to-creatinine ratio is a clinically useful predictor of significant proteinuria (300 mg/24 hour). STUDY DESIGN: The medical records of 138 women who completed both a random urinary protein-to-creatinine ratio and a 24-hour urine collection for the evaluation of preeclampsia were reviewed. Urine samples for the random protein-to-creatinine ratio were collected before the 24-hour urine collection. With the use of a protein level of at least 300 mg in the 24-hour urine sample as the gold standard, the sensitivity and specificity of the random protein-to-creatinine ratio for the diagnosis of significant proteinuria were determined with a range of cutoffs. RESULTS: Fifty percent of the study population had significant proteinuria. The data suggest that a cutoff below 0.14 ruled out significant proteinuria. The best cutoff of > or = 0.19 yields a sensitivity of 90% and a specificity of 70%. All of the false-negative test results had 24-hour urine protein levels below 400 mg; 13 of the 21 false-positive results had levels that ranged from 250 to 300 mg. CONCLUSION: The random urinary protein-to-creatinine ratio is strongly associated with the 24-hour total protein excretion. A level below 0.14 can rule out significant proteinuria. A best cutoff of > or = 0.19 is a good predictor of significant proteinuria. With further study, the random urinary protein-to-creatinine ratio could replace the 24-hour urine collection as a simpler, faster, more useful method for the diagnosis of significant proteinuria.