title: Is the first urinary albumin/creatinine ratio (ACR) in women with suspected preeclampsia a prognostic factor for maternal and neonatal adverse outcome? A retrospective cohort study.
abstract: BACKGROUND
  The aim of this study was to determine the prognostic value of the first urinary albumin/creatinine ratio (ACR) for adverse maternal and neonatal outcomes and how it relates to other prognostic factors.
  
  
  METHODS
  We performed a retrospective cohort study from December 2009 to February 2012 with analysis of demographic, clinical and biochemical data from two obstetric day assessment units in hospitals in Southeast Scotland. We included 717 pregnant women, with singleton pregnancies after 20 weeks' gestation, referred for evaluation of suspected preeclampsia and having their first ACR performed. The ability of ACR to predict future outcomes was assessed in both univariable and multivariable logistic regression models. The latter assessed its prognostic value independent of (adjusting for) existing prognostic factors. Primary outcome measures were maternal and neonatal composite adverse outcomes, and a secondary outcome was gestation at delivery.
  
  
  RESULTS
  In all, 204 women (28.5%) experienced a composite adverse maternal outcome and 146 women (20.4%) experienced a composite adverse neonatal outcome. Multivariate analysis of log-transformed ACR demonstrated that a 1-unit increase in log ACR is associated with an increased odds of adverse maternal [odds ratio 1.60, 95% confidence interval (CI) 1.45-1.80] and adverse neonatal (odds ratio 1.15, 95% CI 1.02-1.29) composite outcomes, and with reduced gestational age at delivery (coefficient: -0.46, 95% CI -0.54 to -0.38).
  
  
  CONCLUSIONS
  ACR is an independent prognostic factor for maternal and neonatal adverse outcomes in suspected preeclampsia. ACR may be useful to inform risk predictions within a prognostic model.
authors.affiliation: Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Eleni G
authors.initials: EG
authors.lastname: Elia
authors.affiliation: The Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Amy O
authors.initials: AO
authors.lastname: Robb
authors.affiliation: Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Karla
authors.initials: K
authors.lastname: Hemming
authors.affiliation: Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Malcolm J
authors.initials: MJ
authors.lastname: Price
authors.affiliation: Primary Care and Health Sciences, Keele University, Newcastle, UK.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Riley
authors.affiliation: The Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: French-Constant
authors.affiliation: Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh Queen's Medical Research Institute, Edinburgh, UK.
authors.forename: Fiona C
authors.initials: FC
authors.lastname: Denison
authors.affiliation: Birmingham Centre for Women's & Newborn's Health, Institute of Metabolism and Systems Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Kilby
authors.affiliation: Birmingham Centre for Women's & Newborn's Health, Institute of Metabolism and Systems Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Rachel K
authors.initials: RK
authors.lastname: Morris
authors.affiliation: Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh Queen's Medical Research Institute, Edinburgh, UK.|School of Women's and Infant's Health, University of Western Australia, The University of Western Australia at King Edward Memorial Hospital, Crawley, WA, Australia.
authors.forename: Sarah J
authors.identifier: http://orcid.org/0000-0003-4308-856X
authors.initials: SJ
authors.lastname: Stock
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000175:diagnosis / Q000652:urine; D015331:Cohort Studies; D003404:Creatinine / Q000652:urine*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011225:Pre-Eclampsia / Q000175:diagnosis* / Q000652:urine; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D011296:Prenatal Diagnosis; D011379:Prognosis; D011507:Proteinuria / Q000175:diagnosis* / Q000652:urine; D012189:Retrospective Studies; D012606:Scotland
chemical_list: D003404:Creatinine
keywords: 
  ACR
  ; Preeclampsia; adverse events; albumin to creatinine ratio; cohort study; prognosis; risk factors