title: Serum activin A does not predict ectopic pregnancy as a single measurement test, alone or as part of a multi-marker panel including progesterone and hCG.
abstract: BACKGROUND
  To evaluate the diagnostic accuracy of activin A alone or in a multi-marker panel for the prediction of ectopic pregnancy (EP).
  
  
  METHODS
  A retrospective analysis was performed on a cohort of 289 women who presented to the emergency department (ED) with vaginal bleeding and/or abdominal pain/cramping and were diagnosed with EP, spontaneous abortion, or viable intrauterine pregnancy. Serum progesterone, hCG, and activin A concentrations were measured on the samples obtained in the ED. Statistical analysis was performed to determine the clinical utility of these biomarkers as single measurement and as a multi-marker panel test for ectopic pregnancy. Women ≥18 y with vaginal bleeding or abdominal pain/cramping.
  
  
  RESULTS
  Progesterone (<10 ng/ml), hCG (<6,699 IU/l), and activin A (<0.26 ng/ml) cutoffs were optimized by ROC analysis. These demonstrated sensitivities of 62.9%, 74.2%, and 59.6%, and specificities of 60.5%, and 63.0%, and 61.0% respectively for detecting EP. The multi-marker panel utilizing all three biomarkers had a sensitivity of 70% and specificity of 69%.
  
  
  CONCLUSIONS
  Serum activin A cannot be used as a single measurement or in a multi-marker panel with progesterone and hCG to predict EP.
authors.affiliation: Washington University School of Medicine, Pathology and Immunology, St. Louis, MO 63110, United States. jwarrick@path.wustl.edu
authors.forename: Joshua
authors.initials: J
authors.lastname: Warrick
authors.forename: Ann
authors.initials: A
authors.lastname: Gronowski
authors.forename: Courtney
authors.initials: C
authors.lastname: Moffett
authors.forename: Quihong
authors.initials: Q
authors.lastname: Zhao
authors.forename: Emily
authors.initials: E
authors.lastname: Bishop
authors.forename: Alison
authors.initials: A
authors.lastname: Woodworth
mesh_terms: D028341:Activins / Q000097:blood*; D015415:Biomarkers / Q000097:blood*; D006063:Chorionic Gonadotropin / Q000097:blood*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000175:diagnosis*; D011374:Progesterone / Q000097:blood*
chemical_list: D015415:Biomarkers; D006063:Chorionic Gonadotropin; C422405:activin A; D028341:Activins; D011374:Progesterone