Protein Creatinine ratio versus 24-h test in HIV-positive and HIV-negative women with pre-eclampsia

Pre-eclampsia (PE) is a major contributing factor to high rates of maternal and perinatal morbidity and mortality in South Africa. Early diagnosis is currently a challenge. The objective is to assess the diagnostic accuracy of spot urine protein-creatinine (P/C) ratio (UPCR) in comparison with 24-h urine proteinuria assessment for predicting PE.

This was a prospective cross-sectional analytical study. A total of 125 women were included in the study and divided into normotensives (n = 25), early onset PE (n = 25), late onset PE (n = 25), chronic hypertension (n = 25) and gestational hypertension (n = 25) groups. Spot urine P/C ratio was determined in a mid-stream urine sample, and the 24-h urine protein was measured by standard laboratory techniques, and comparisons of the results were made between the groups.

A significant difference was found in the spot protein-creatinine ratios (PCRs) between normotensives and early onset PE (p  0.0001) and between normotensives and late onset PE groups (p = 0.001). No significant differences were found between the 24-h urine and spot protein-creatinine across all groups: normotensives (p = 0.18); early onset PE (p = 0.63); late onset (p = 0.60); chronic hypertension (p = 0.43) and gestational hypertension (p = 0.95). In women with human immunodeficiency virus (HIV), no statistical significance was noted between the 24-hour test and the spot PCR.

Spot PCR is a reliable test for quantifying proteinuria in all pregnant women, as the results were similar to that of a 24-h urine proteinuria test regardless of their HIV status. This shows that the spot PCR yields accurate results. The 24-hour test is inconvenient for pregnant women with and without HIV and is also expensive and time-consuming.Contribution: The UPCR can be introduced as an additional gold standard of PE analysis, especially in outpatients.