Résumé
Aims: The present study was undertaken to evaluate the diagnostic value of protein:creatinine ratio in spot voided urine sample for detection of proteinuria as compared to those of 24 hour urine sample in patients with preeclampsia, and also to determine the optimal cut-off value of protein:creatinine ratio with best sensitivity and specificity for the prediction of significant proteinuria. Study Design: Cross sectional study. Place and Duration of the Study: The study was conducted at teaching hospital in North Karnatak, India. The study was conducted from Jan 2012 to February 2013. Methods: This study was conducted on 52 preeclampsia patients. The 24 hour urine protein and random urine protein:creatinine ratio was determined. Pearson’s correlation, sensitivity and specificity were determined using 24-hour urinary protein as a gold standard for spot urine protein:creatinine ratio. Receiver operators characteristic (ROC) curve and area under curve was also determined using SPSS (11.5) software. All the results were expressed in mean±SD. Results: Fifty two preeclampsia patients participated in this study. The average 24 hour urinary protein was 1643.3±2079.5 mg/day. The spot urine protein:creatinine ratio was 1.47±1.68. There was a positive correlation between 24 hour urinary protein and spot urine protein:creatinine ratio (r = 0.86, P<0.0001). The area under the receiver operators characteristic curve for urine protein:creatinine ratio at various cut-off was 0.914 (95% confidence interval: 0.800-0.975, P<0.0001). The sensitivity and specificity was 71.5% and 100% respectively at protein:creatinine ratio cut-off of 0.66. Conclusion: The random urine protein:creatinine ratio predicts the amount of 24-hour urinary protein excretion with high accuracy. Hence it can be used as a faster diagnostic substitute for 24- hour urinary protein estimation in preeclampsia.
Résumé
Background: Pregnancy is a complex endocrine-metabolic adaptation and diabetogenic condition involving impaired cellular insulin sensitivity, increased β-cell function, and moderate elevation of blood glucose level. The threshold for a positive glucose challenge test (GCT) necessitating further diagnostic testing remains controversial in gestational diabetes mellitus (GDM). Aims & Objective: To find the association of risk factors with GDM, to evaluate the diagnostic value of GCT as compared to oral glucose tolerance test (OGTT) in GDM, and also to determine the optimal cut-off value of GCT with best sensitivity and specificity for the prediction of GDM and also to find the association of GCT between FBS and 2nd hour OGTT glucose level. Material and Methods: The study was conducted at Hanagal Shri Kumareshwara Hospital, Bagalkot, Karnataka, India, from June 2009 to February 2010. 247 pregnant women were selected for the study. Selected women were subjected to screening by GCT. If the blood glucose level was greater than 140 mg/dl, the GCT was considered as positive and these patients were subjected to 75 gm OGTT to confirm the diagnosis of GDM. The diagnosis of GDM was based on WHO criteria. Results: In the present study out of 247 pregnant women selected, 199 women participated, of which 26(13.06%) of the pregnant women were diagnosed to have GDM. Mean age of the study subjects was 24.7±3.51 years. There was a positive association of GDM with age, BMI, glucosuria, polyhydraromnios, obstetrics score, previous GDM, past history of unexplained IUD, family history of DM, recurrent vaginal infection. Area under the curve is 0.994 (p>0.0001) which has best diagnostic accuracy at glucose level of 128 mg/dl, as the best cut off value. Second hour OGTT is more correlated with GCT than FBS. Conclusion: In this ethnic group, the high risk pregnant women for GDM should undergo initial 50 gm. GCT. If GCT value is more than 128 mg/dl, it should be followed by second hour 75 gram OGTT, for the diagnosis of GDM and it reduces the FBS estimation of blood sugar level and an extra prick too.
Résumé
Background: Pregnancy is a complex endocrine-metabolic adaptation and diabetogenic condition involving impaired cellular insulin sensitivity, increased β-cell function, and moderate elevation of blood glucose level. The threshold for a positive glucose challenge test (GCT) necessitating further diagnostic testing remains controversial in gestational diabetes mellitus (GDM). Aims & Objective: To find the association of risk factors with GDM, to evaluate the diagnostic value of GCT as compared to oral glucose tolerance test (OGTT) in GDM, and also to determine the optimal cut-off value of GCT with best sensitivity and specificity for the prediction of GDM and also to find the association of GCT between FBS and 2nd hour OGTT glucose level. Material and Methods: The study was conducted at Hanagal Shri Kumareshwara Hospital, Bagalkot, Karnataka, India, from June 2009 to February 2010. 247 pregnant women were selected for the study. Selected women were subjected to screening by GCT. If the blood glucose level was greater than 140 mg/dl, the GCT was considered as positive and these patients were subjected to 75 gm OGTT to confirm the diagnosis of GDM. The diagnosis of GDM was based on WHO criteria. Results: In the present study out of 247 pregnant women selected, 199 women participated, of which 26(13.06%) of the pregnant women were diagnosed to have GDM. Mean age of the study subjects was 24.7±3.51 years. There was a positive association of GDM with age, BMI, glucosuria, polyhydraromnios, obstetrics score, previous GDM, past history of unexplained IUD, family history of DM, recurrent vaginal infection. Area under the curve is 0.994 (p>0.0001) which has best diagnostic accuracy at glucose level of 128 mg/dl, as the best cut off value. Second hour OGTT is more correlated with GCT than FBS. Conclusion: In this ethnic group, the high risk pregnant women for GDM should undergo initial 50 gm. GCT. If GCT value is more than 128 mg/dl, it should be followed by second hour 75 gram OGTT, for the diagnosis of GDM and it reduces the FBS estimation of blood sugar level and an extra prick too.