DIAGNOSTIC ACCURACY OF SPOT URINARY PROTEIN TO CREATININE RATIO IN PREGNANT FEMALES WITH PRE-ECLAMPSIA KEEPING 24 HOURS URINARY PROTEIN AS GOLD STANDARD

Abstract

Background: Accurate quantification of proteinuria is essential in evaluating pre-eclampsia. Twenty-four-hour urinary protein is considered the reference standard but is time-consuming and prone to collection errors. The spot urinary protein-to-creatinine ratio (PCR) offers a rapid alternative.

Objective: To evaluate the diagnostic accuracy of spot urinary protein-to-creatinine ratio for detecting significant proteinuria (≥300 mg/24h) using 24-hour urinary protein as the reference standard.

Methods: This prospective diagnostic accuracy study was conducted at Sheikh Zayed Hospital, Rahim Yar Khan. Two hundred fifty pregnant women with pre-eclampsia (defined according to ISSHP 2021 criteria) were enrolled consecutively. Significant proteinuria was defined as ≥300 mg/24h. A PCR cut-off >0.30 was considered positive. Sensitivity, specificity, predictive values, accuracy, and 95% confidence intervals were calculated.

Results: Significant proteinuria was present in 111/250 (44.4%) women. Spot PCR was positive in 109 women. Compared with 24-hour urinary protein, there were 102 true positives, 132 true negatives, 7 false positives, and 9 false negatives. Sensitivity was 91.9% (95% CI: add), specificity 95.0% (95% CI: add), PPV 93.6%, NPV 93.6%, and overall accuracy 93.6%.

Conclusion: Spot urinary protein-to-creatinine ratio demonstrates high diagnostic accuracy for detecting significant proteinuria and may serve as a reliable alternative to 24-hour urine collection in tertiary care settings.