Accuracy of serum uric acid determination in predicting pre-eclampsia: a systematic review.
BACKGROUND
Pre-eclampsia is a leading cause of maternal and perinatal mortality and morbidity. Early prediction of pre-eclampsia may be used to target high-risk women for effective preventative treatments. Hyperuricemia is associated with pre-eclampsia and it has been tested in early pregnancy for its ability to predict the later onset of the disease.


OBJECTIVE
To systematically review the accuracy of determining serum uric acid before the 25th gestational week in predicting pre-eclampsia.


METHODS
We searched Medline, Embase, Cochrane Library, Medion, bibliographies of review articles and eligible primary studies, and contacted experts in the field. Language restrictions were not applied. Reviewers working independently selected studies, extracted data and assessed validity according to eight criteria. Sensitivities and specificities were plotted in a Receiver Operating Characteristic plot.


RESULTS
We identified five primary articles, with a total of 572 women, including 44 who developed pre-eclampsia. Study populations differed clinically, with incidences ranging from 3.4% to 40.1%. Sensitivity ranged from 0.0% to 55.6% and specificity ranged from 76.9% to 94.9%. Clinical heterogeneity and poor reporting precluded sensible pooling of data. In particular, consecutive entry of eligible women, blind assessment of the reference standard, and treatment to prevent pre-eclampsia were poorly reported.


CONCLUSIONS
Contrary to previous reviews, we conclude that there is currently insufficient evidence to draw firm conclusions about the accuracy of serum uric acid determination in predicting pre-eclampsia.
Cnossen
Jeltsje S
JS
Department of General Practice, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands. j.s.cnossen@amc.uva.nl
de Ruyter-Hanhijärvi
Hanna
H
van der Post
Joris A M
JA
Mol
Ben W J
BW
Khan
Khalid S
KS
ter Riet
Gerben
G
D005260:Female; D006801:Humans; D011225:Pre-Eclampsia / Q000097:blood* / Q000175:diagnosis; D011237:Predictive Value of Tests; D011247:Pregnancy; D014527:Uric Acid / Q000097:blood*
D014527:Uric Acid