title: The role of HCG increment in the 48h prior to methotrexate treatment as a predictor for treatment success.
abstract: OBJECTIVE
  To evaluate the role HCG change in the 48h prior to methotrexate treatment as a predictor for treatment success.
  
  
  METHODS
  Medical records of all women who were diagnosed with ectopic pregnancy between January 2001 and June 2013 were reviewed. Four hundred and nine patients received methotrexate due to ectopic pregnancy. The "single dose" methotrexate protocol with 50mg/m2was administered to patients with progressing ectopic pregnancy. HCG levels in days 1, 4 and 7 were used to evaluate methotrexate treatment success. The percentage of HCG change in the 48h prior to methotrexate treatment was compared between patients who were successfully treated and those who failed treatment with methotrexate.
  
  
  RESULTS
  Single dose methotrexate was successful in 309 patients (75.4%, success group). The medians of HCG change in the 48h prior to methotrexate administration were significantly higher in the "failure group" (21% vs. 4%, p<0.01). In a logistic regression analysis, the of HCG percent increment prior to methotrexate administration was shown to be an independent predictor for treatment outcome. Receiver operator characteristic curve for HCG percent change was 0.751, at a cutoff value of HCG increment <12% the positive predictive value for treatment success reached 86%.
  
  
  CONCLUSIONS
  Percentage of HCG increment in the 48h prior to methotrexate administration is an independent predictor for methotrexate treatment success. HCG increment <12% prior to methotrexate treatment is a good predictor for treatment success.
authors.affiliation: Department of Gynecology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Israel. Electronic address: co.aviad@gmail.com.
authors.forename: Aviad
authors.initials: A
authors.lastname: Cohen
authors.affiliation: Department of Gynecology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Israel.
authors.forename: Benny
authors.initials: B
authors.lastname: Almog
authors.affiliation: Department of Gynecology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Israel.
authors.forename: Yoni
authors.initials: Y
authors.lastname: Cohen
authors.affiliation: Department of Gynecology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Israel.
authors.forename: Guy
authors.initials: G
authors.lastname: Bibi
authors.affiliation: Department of Gynecology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Israel.
authors.forename: Eli
authors.initials: E
authors.lastname: Rimon
authors.affiliation: Department of Gynecology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Israel.
authors.forename: Ishai
authors.initials: I
authors.lastname: Levin
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use*; D000328:Adult; D006063:Chorionic Gonadotropin / Q000097:blood*; D005260:Female; D006801:Humans; D008499:Medical Records; D008727:Methotrexate / Q000627:therapeutic use*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000097:blood / Q000188:drug therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D006063:Chorionic Gonadotropin; D008727:Methotrexate
keywords: Ectopic pregnancy; Human chorionic gonadotropin; Methotrexate