Photo Credit: Sasirin Pamai
Research indicated that the P/C ratio offers a quicker and more effective method for identifying significant proteinuria in the context of preeclampsia risk stratification.
Preeclampsia remains a major cause of maternal and neonatal morbidity worldwide, necessitating accurate and efficient diagnostic tools. Early and accurate diagnosis is key to preventing severe outcomes in the 3% to 5% of pregnancies it affects.
Traditionally, 24-hour urine protein collection has been the gold standard for assessing proteinuria, but it has practical limitations, including long turnaround times, collection errors, and patient inconvenience.
Authors of a comparative study published in the Journal of Gynecology Obstetrics and Human Reproduction investigated the protein-to-creatinine (P/C) ratio as a faster, more efficient alternative for identifying significant proteinuria in patients with preeclampsia.
“In non-pregnant patients, studies have shown a strong correlation between the P/C ratio in a urine sample and 24-hour proteinuria levels. In pregnant patients, the potential of the P/C ratio as a diagnostic tool for preeclampsia has been demonstrated, and its effectiveness in screening for preeclampsia with a defined P/C ratio of greater than or equal to 30 mg/mmol has been validated,” wrote Victoire de Logivière, DU, and colleagues. “However, to our knowledge, no studies in pregnant women have yet evaluated the correlation between the P/C ratio and 24-hour proteinuria for high levels of proteinuria (>3 g/24 hours) in everyday clinical practice.”
Inside the Study
This retrospective, single-center analysis was conducted between January 2019 and November 2020. It included pregnant patients hospitalized for preeclampsia, defined as systolic blood pressure of at least 140 mmHg and/or diastolic blood pressure of 90 mmHg or higher, with proteinuria of at least 0.3 g/24 hours or a P/C ratio of 300 mg/mmol and above after 20 weeks of gestation.
Researchers compared P/C ratio measurements with traditional 24-hour urine protein values, assessing their agreement and predictive value for maternal and neonatal complications. Statistical analyses, including logistic regression and ROC curves, were used to evaluate the accuracy and clinical relevance of the P/C ratio in diagnosing severe proteinuria and predicting adverse outcomes.
The study yielded the following outcomes:
Clinical Implications
The researchers concluded that using the P/C ratio in clinical practice can significantly enhance preeclampsia management.
“Clinically, the strong agreement between the P/C ratio and the 24-hour proteinuria measurement suggests that the P/C ratio can be a reliable and faster alternative for assessing the severity of preeclampsia,” Dr. de Logivière and colleagues said.
They added that the P/C ratio can improve the patient experience because it requires a single urine sample rather than 24-hour urine collection, which “can be particularly uncomfortable and burdensome for pregnant women, especially in the third trimester.”
The researchers noted several limitations. This was a single-center study, limiting its generalizability to diverse populations. The data were collected retrospectively, introducing potential biases. The authors called for larger, multicenter prospective studies to confirm these findings and establish standardized thresholds across different populations.
“At these thresholds, both measurements were associated with a significantly increased risk of adverse perinatal outcomes. The P/C ratio offers a quicker and simpler alternative to the 24-hour proteinuria measurement, potentially facilitating more timely and effective management of preeclampsia,” Dr. de Logivière and colleagues concluded.
