Dataset Information

Is the first urinary albumin/creatinine ratio (ACR) in women with suspected preeclampsia a prognostic factor for maternal and neonatal adverse outcome? A retrospective cohort study.

ABSTRACT:

Introduction

The aim of this study was to determine the prognostic value of the first urinary albumin/creatinine ratio (ACR) for adverse maternal and neonatal outcomes and how it relates to other prognostic factors.

Material and methods

We performed a retrospective cohort study from December 2009 to February 2012 with analysis of demographic, clinical and biochemical data from two obstetric day assessment units in hospitals in Southeast Scotland. We included 717 pregnant women, with singleton pregnancies after 20 weeks' gestation, referred for evaluation of suspected preeclampsia and having their first ACR performed. The ability of ACR to predict future outcomes was assessed in both univariable and multivariable logistic regression models. The latter assessed its prognostic value independent of (adjusting for) existing prognostic factors. Primary outcome measures were maternal and neonatal composite adverse outcomes, and a secondary outcome was gestation at delivery.

Results

In all, 204 women (28.5%) experienced a composite adverse maternal outcome and 146 women (20.4%) experienced a composite adverse neonatal outcome. Multivariate analysis of log-transformed ACR demonstrated that a 1-unit increase in log ACR is associated with an increased odds of adverse maternal [odds ratio 1.60, 95% confidence interval (CI) 1.45-1.80] and adverse neonatal (odds ratio 1.15, 95% CI 1.02-1.29) composite outcomes, and with reduced gestational age at delivery (coefficient: -0.46, 95% CI -0.54 to -0.38).

Conclusions

ACR is an independent prognostic factor for maternal and neonatal adverse outcomes in suspected preeclampsia. ACR may be useful to inform risk predictions within a prognostic model.

SUBMITTER: Elia EG

PROVIDER: S-EPMC5413808 | biostudies-literature | 2017 May

REPOSITORIES: biostudies-literature

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Publications

Is the first urinary albumin/creatinine ratio (ACR) in women with suspected preeclampsia a prognostic factor for maternal and neonatal adverse outcome? A retrospective cohort study.

Elia Eleni G EG Robb Amy O AO Hemming Karla K Price Malcolm J MJ Riley Richard D RD French-Constant Anna A Denison Fiona C FC Kilby Mark D MD Morris Rachel K RK Stock Sarah J SJ

Acta obstetricia et gynecologica Scandinavica 20170324 5

<h4>Introduction</h4>The aim of this study was to determine the prognostic value of the first urinary albumin/creatinine ratio (ACR) for adverse maternal and neonatal outcomes and how it relates to other prognostic factors.<h4>Material and methods</h4>We performed a retrospective cohort study from December 2009 to February 2012 with analysis of demographic, clinical and biochemical data from two obstetric day assessment units in hospitals in Southeast Scotland. We included 717 pregnant women, wi ...[more]

PMID: 28247485

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Project description:ImportanceAlthough cumulative evidence suggests that elevated urinary albumin-to-creatinine ratio (UACR) in the normal range (<30 mg/g) may be associated with an increased risk of mortality, few studies have investigated whether cardiovascular health (CVH) modifies the harmful outcomes of high-normal UACR.ObjectiveTo investigate associations of traditionally normal UACR and CVH with all-cause mortality.Design, setting, and participantsThis cohort study used National Health and Nutrition Examination Survey data from 2005 through 2018 and linked mortality information until 2019. Data were analyzed from March 1 through October 31, 2023. The study included adult participants aged 20 to 79 years with a normal UACR (<30 mg/g) based on Kidney Disease: Improving Global Outcomes criteria.ExposuresThe UACR was treated as a continuous variable and categorized into tertiles delineated as low (<4.67 mg/g), medium (4.67-7.67 mg/g), and high (7.68 to <30 mg/g). Cardiovascular health was assessed using Life's Essential 8 scores and grouped as poor (0-49 points), moderate (50-79 points), and ideal (80-100 points).Main outcomes and measuresMultivariable Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% CIs for associations of UACR with all-cause mortality in total participants and as stratified by CVH groups.ResultsThe study included 23 697 participants (mean [SD] age, 45.58 [15.44] years; 11 806 women [49.7%] and 11 891 men [50.3%]). During the median 7.8 years (range, 4.5-11.1 years) of follow-up, 1403 deaths were recorded. Near-linear associations were observed for continuous UACR and CVH with all-cause mortality. Compared with the low UACR group, high UACR in the normal range showed an increased mortality risk in the moderate and poor CVH groups (CVH [50-79]: HR, 1.54 [95% CI, 1.26-1.89]; CVH [0-49]: HR, 1.56 [95% CI, 1.10-2.20]), with a significant multiplicative interaction of UACR and CVH (P < .001).Conclusions and relevanceThe findings suggest that high UACR within the normal range is associated with a significantly increased risk of all-cause mortality, with the association more pronounced in adults with poor CVH status. These findings highlight the importance of risk management for early kidney dysfunction, particularly among individuals with poor CVH.

Project description:BackgroundPeople living with HIV (PLWH) in sub-Saharan Africa are vulnerable to end organ dysfunction such as albuminuria, which is associated with an increased risk of cardiovascular and renal events. However, the prevalence of persistent albuminuria among PLWH in Africa is unclear. This observational prospective study assessed for persistence of albuminuria in a cohort of PLWH on longterm antiretroviral therapy (ART) across various HIV service platforms in Gaborone, Botswana.MethodsA subgroup of ART treated PLWH (n = 867) from a larger cross-sectional study (n = 1537) assessing prevalence of albuminuria among PLWH at a referral hospital HIV clinic and satellite HIV clinics in Gaborone, were invited to participate in a 12-month long albuminuria prospective cohort study between January 2020 and March 2022. During three planned study visits, albumin-creatinine (ACR) was computed using urine albumin measured using immunoturbidimetric assay and urine creatinine using colorimetric assay (Jaffe method), at the Botswana Harvard HIV Reference Laboratory. ACR trajectory groups were identified using growth mixture models, and factors associated with ACR trajectory were analyzed using modified Poisson regression.ResultsAmong the 623 adults with complete data for all 3 study visits, their baseline median age was 50 (42-57) years with a median HIV disease duration of 13.1 (8.7-16.7) years, and 266 (42.7%) of them were female. Study participants were categorized into two ACR trajectory groups: low increasing ACR, N = 290 (46.5%) and moderate increasing ACR, N = 333 (53.5%) groups. ACR increased by 4.7 mg/g in the slow increasing ACR groups versus 11.5 mg/g in the moderate increasing ACR trajectory group by end of follow-up. Active use of Tenofovir, aRR 1.27 [95% CI 1.02-1.60], p = 0.036, or ACEi/ARB, aRR 1.31 [95% CI 1.07-1.61], p = 0.008, and an elevated baseline ACR, aRR 1.34 [95% CI 1.28-1.41], p < 0.001, were all associated with being in the moderate increasing ACR trajectory group.ConclusionChronic, treated HIV infection was associated with more than 5 fold increase in ACR over 12 months. Future studies should explore the extent to which modifiable risk factors and HIV specific factors for progressive increase in albuminuria could be aggressively controlled among PLWH.

Dataset Information

Is the first urinary albumin/creatinine ratio (ACR) in women with suspected preeclampsia a prognostic factor for maternal and neonatal adverse outcome? A retrospective cohort study.

Introduction

Material and methods

Results

Conclusions

Publications

Is the first urinary albumin/creatinine ratio (ACR) in women with suspected preeclampsia a prognostic factor for maternal and neonatal adverse outcome? A retrospective cohort study.

Similar Datasets

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