Podocalyxin as biomarker for early detection of preeclampsia: A systematic review and meta-analysis

This study aims to investigate the diagnostic performance of Podocalyxin for the early detection of Preeclampsia METHODS: This systematic review and meta-analysis followed PRISMA guidelines and was prospectively registered in PROSPERO CRD420261369096. A comprehensive search of PubMed, Scopus, Web of Science, CINAHL, and the Cochrane Library was conducted from inception to May 2026. Methodological quality was assessed using QUADAS-2 and the Joanna Briggs Institute (JBI) tools. Diagnostic accuracy outcomes were synthesized using a bivariate random-effects model. Summary receiver operating characteristic (SROC) curves were constructed to evaluate overall test performance. In addition, pooled standardized mean differences (SMD) were calculated using a random-effects model with 95% confidence intervals (CI). Heterogeneity was assessed using the I² statistic and Cochran's Q test. Statistical significance was set at P < 0.05.

Sixteen studies published between 2007 and 2026 across diverse populations were included. Seven studies were eligible for diagnostic accuracy meta-analysis. Most studies measure Podocalyxin using ELISA with reported sensitivities ranging from 36.1% to 100% and specificities from 75% to 98%. Overall, the pooled sensitivity was 83% (95% CI: 0.78-0.88) and specificity of 83% (95% CI: 0.80-0.87). The SROC curve demonstrated excellent diagnostic performance (AUC = 0.94). No significant threshold effect was observed (Spearman correlation = -0.234, p = 0.613). The pooled positive likelihood ratio was 5.91 (95% CI: 2.89-12.06), and the negative likelihood ratio was 0.11 (95% CI: 0.03-0.52). Fourteen studies were eligible to estimate effect size. Maternal Podocalyxin levels were significantly higher in women with PE compared to controls (SMD = 1.05; 95% CI: 0.71-1.39, p < 0.0001). Sensitivity analysis identified one influential study and its exclusion reduced heterogeneity to I² = 78.3%.

Podocalyxin shows strong potential as a non-invasive biomarker for the early detection of PE, though our findings predominantly reflect proteinuric presentations. Well-designed, large-scale prospective studies are needed to confirm generalizability across the full PE spectrum and support clinical implementation.