title: PIERS proteinuria: relationship with adverse maternal and perinatal outcome.
abstract: OBJECTIVE
  To examine the ability of three different proteinuria assessment methods (urinary dipstick, spot urine protein:creatinine ratio [Pr/Cr], and 24-hour urine collection) to predict adverse pregnancy outcomes.
  
  
  METHODS
  We performed a prospective multicentre cohort study, PIERS (Preeclampsia Integrated Estimate of RiSk), in seven academic tertiary maternity centres practising expectant management of preeclampsia remote from term in Canada, New Zealand, and Australia. Eligible women were those admitted with preeclampsia who had at least one antenatal proteinuria assessment by urinary dipstick, spot urine Pr/Cr ratio, and/or 24-hour urine collection. Proteinuria assessment was done either visually at the bedside (by dipstick) or by hospital clinical laboratories for spot urine Pr/Cr and 24-hour urine collection. We calculated receiver operating characteristic area under the curve (95% CI) for each proteinuria method and each of the combined adverse maternal outcomes (within 48 hours) or adverse perinatal outcomes (at any time). Models with AUC ≥ 0.70 were considered of interest. Analyses were run for all women who had each type of proteinuria assessment and for a cohort of women ("ALL measures") who had all three proteinuria assessments.
  
  
  RESULTS
  More women were proteinuric by urinary dipstick (≥ 2+, 61.4%) than by spot urine Pr/Cr (≥ 30 g/mol, 50.4%) or 24-hour urine collection (≥ 0.3g/d, 34.7%). Each proteinuria measure evaluated had some discriminative power, and dipstick proteinuria (categorical) performed as well as other methods. No single method was predictive of adverse perinatal outcome.
  
  
  CONCLUSIONS
  The measured amount of proteinuria should not be used in isolation for decision-making in women with preeclampsia. Dipstick proteinuria performs as well as other methods of assessing proteinuria for prediction of adverse events.
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia Vancouver BC; CFRI Reproduction and Healthy Pregnancy Cluster, University of British Columbia Vancouver BC.
authors.forename: Beth
authors.initials: B
authors.lastname: Payne
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia Vancouver BC; CFRI Reproduction and Healthy Pregnancy Cluster, University of British Columbia Vancouver BC; Department of Health Care and Epidemiology, University of British Columbia Vancouver BC; Department of Medicine, University of British Columbia Vancouver BC.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Magee
authors.affiliation: Département de Médecine, Université de Sherbrooke, Sherbrooke QC.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Côté
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia Vancouver BC; CFRI Reproduction and Healthy Pregnancy Cluster, University of British Columbia Vancouver BC; Department of Health Care and Epidemiology, University of British Columbia Vancouver BC.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Hutcheon
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia Vancouver BC; CFRI Reproduction and Healthy Pregnancy Cluster, University of British Columbia Vancouver BC.
authors.forename: Jing
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authors.lastname: Li
authors.affiliation: Department of Obstetrics and Gynaecology, University of Otago Christchurch New Zealand.
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authors.lastname: Kyle
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia Vancouver BC; CFRI Reproduction and Healthy Pregnancy Cluster, University of British Columbia Vancouver BC.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Menzies
authors.affiliation: Department of Medicine, University of Otago, Christchurch New Zealand.
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authors.lastname: Peter Moore
authors.affiliation: Department of Obstetrics and Gynaecology, King Edward Memorial Hospital WA Australia.
authors.forename: Claire
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authors.lastname: Parker
authors.affiliation: Department of Obstetrics and Gynaecology, University of Otago Christchurch New Zealand.
authors.forename: Barbra
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authors.lastname: Pullar
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia Vancouver BC; CFRI Reproduction and Healthy Pregnancy Cluster, University of British Columbia Vancouver BC; Department of Health Care and Epidemiology, University of British Columbia Vancouver BC.
authors.forename: Peter
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authors.lastname: von Dadelszen
authors.affiliation: Department of Obstetrics and Gynaecology, King Edward Memorial Hospital WA Australia; Department of Medicine, King Edward Memorial Hospital WA Australia.
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authors.lastname: von Dadelszen
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authors.lastname: Keith Still
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authors.affiliation: Uganda.
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authors.lastname: Biryabarema
authors.affiliation: Uganda.
authors.forename: Florence
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authors.lastname: Mirembe
authors.affiliation: Uganda.
authors.forename: Annettee
authors.initials: A
authors.lastname: Nakimuli
authors.affiliation: Preeclampsia Foundation United States.
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mesh_terms: D000328:Adult; D015331:Cohort Studies; D003404:Creatinine / Q000652:urine; D005260:Female; D005865:Gestational Age; D006801:Humans; D011225:Pre-Eclampsia / Q000175:diagnosis / Q000652:urine*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D011507:Proteinuria / Q000175:diagnosis*; D012372:ROC Curve; D011934:Reagent Strips; D012307:Risk Factors; D059349:Urine Specimen Collection / Q000379:methods
chemical_list: D011934:Reagent Strips; D003404:Creatinine