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Accuracy of serum uric acid determination in predicting pre-eclampsia: a systematic review
Jeltsje S Cnossen1, Hanna de Ruyter-Hanhijärvi, Joris A M van der Post
1Department of General Practice, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands. j.s.cnossen@amc.uva.nl
Insights
Early prediction of pre-eclampsia is crucial. However, current evidence suggests insufficient data on the accuracy of serum uric acid levels in predicting pre-eclampsia before 25 weeks gestation.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Clinical Chemistry
Background:
- Pre-eclampsia poses significant risks to maternal and perinatal health.
- Early prediction of pre-eclampsia is vital for implementing timely preventative interventions.
- Hyperuricemia (high uric acid levels) has been investigated as a potential early predictor of pre-eclampsia.
Purpose of the Study:
- To systematically review the diagnostic accuracy of serum uric acid measurements in early pregnancy (before 25 weeks gestation) for predicting pre-eclampsia.
Main Methods:
- Comprehensive literature search across multiple databases (Medline, Embase, Cochrane Library, Medion) and expert consultation.
- Independent study selection, data extraction, and validity assessment by reviewers.
- Analysis of sensitivity and specificity using Receiver Operating Characteristic (ROC) plots.
Main Results:
- Five studies involving 572 women (44 with pre-eclampsia) were included.
- Significant clinical heterogeneity and poor reporting of study methodologies were observed.
- Sensitivity ranged from 0.0% to 55.6%, and specificity ranged from 76.9% to 94.9%.
Conclusions:
- Current evidence is insufficient to establish the accuracy of serum uric acid for predicting pre-eclampsia.
- Heterogeneity and methodological limitations in existing studies preclude definitive conclusions.
- Further high-quality research is needed to clarify the predictive value of serum uric acid.
Background:
Pre-eclampsia is a leading cause of maternal and perinatal mortality and morbidity. Early prediction of pre-eclampsia may be used to target high-risk women for effective preventative treatments. Hyperuricemia is associated with pre-eclampsia and it has been tested in early pregnancy for its ability to predict the later onset of the disease.
Objective:
To systematically review the accuracy of determining serum uric acid before the 25th gestational week in predicting pre-eclampsia.
Methods:
We searched Medline, Embase, Cochrane Library, Medion, bibliographies of review articles and eligible primary studies, and contacted experts in the field. Language restrictions were not applied. Reviewers working independently selected studies, extracted data and assessed validity according to eight criteria. Sensitivities and specificities were plotted in a Receiver Operating Characteristic plot.
Results:
We identified five primary articles, with a total of 572 women, including 44 who developed pre-eclampsia. Study populations differed clinically, with incidences ranging from 3.4% to 40.1%. Sensitivity ranged from 0.0% to 55.6% and specificity ranged from 76.9% to 94.9%. Clinical heterogeneity and poor reporting precluded sensible pooling of data. In particular, consecutive entry of eligible women, blind assessment of the reference standard, and treatment to prevent pre-eclampsia were poorly reported.
Conclusion:
Contrary to previous reviews, we conclude that there is currently insufficient evidence to draw firm conclusions about the accuracy of serum uric acid determination in predicting pre-eclampsia.
