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5. Contemporary Test Performance of the Random Urine Protein-to-creatinine Ratio.

Author

Champion, Macie L., Becker, David A., McIlwraith, Claire, Blanchard, Christina T., Szychowski, Jeff M., Kim, Dhong-Jin, Jauk, Victoria C., Harper, Lorie M., Casey, Brian M., and Tita, Alan T.

Subjects
PROTEINURIA diagnosis, PROTEINS, PREDICTIVE tests, PEARSON correlation (Statistics), CREATININE, RECEIVER operating characteristic curves, RETROSPECTIVE studies, LONGITUDINAL method, HYPERTENSION in pregnancy, PREGNANCY complications, URINE collection & preservation, CONFIDENCE intervals, REGRESSION analysis, SENSITIVITY & specificity (Statistics), PREGNANCY
Abstract

Objective The random urine protein-to-creatinine ratio (UPCR) is a screening test used for predicting clinically significant proteinuria (urine protein ≥ 300 mg) during pregnancy. No consensus exists on the optimal random UPCR cutoff for performing follow-up 24 hour urine (24H) total protein collection. We aim to evaluate the test performance of random UPCR in predicting proteinuria in a contemporary cohort. Study Design This was a retrospective cohort study of pregnant patients at our institution from 2014 to 2018 with a random UPCR and follow-up 24H protein collection. The primary analysis estimated the test characteristics (sensitivity, specificity, positive and negative predictive values) of using random UPCR for the detection of proteinuria defined as urine protein ≥300 mg on 24H protein collection. UPCR cutoffs from 0.10 to 0.30 mg/dL were evaluated, receiver operator characteristic (ROC) curve was constructed, and area under the curve (AUC) was determined. A secondary analysis examined the correlation between UPCR and 24H protein using least squares regression and Pearson correlation. Results Paired UPCR and 24H collection results were available for 1,120 patients. Mean gestational age at time of UPCR was 31.1 ± 5.1 weeks and 687 (61.3%) of patients had a 24H ≥300 mg. UPCR <0.10 mg/dL effectively excluded proteinuria ≥300 mg on 24H collection, while UPCR ≥0.18 mg/dL correctly classifies proteinuria with 91% sensitivity, 57% specificity, 77% positive predictive value, and 79% negative predictive value. UPCR ≥1.07 mg/dL had 100% specificity for 24 hour proteinuria. The area under ROC curve was 0.86. UPCR and 24H collection were highly correlated with a Pearson correlation coefficient of 0.85. After our institution lowered the threshold to obtain a 24H from UPCR ≥0.20 mg/dL to ≥0.10 mg/dL in May 2017, the percentage of patients meeting criteria for 24H collection increased from 57.8 to 84.4%. Conclusion The AUC and Pearson correlation suggest random UPCR is a high performance test for the prediction of proteinuria on 24H. Optimal test performance is dependent upon clinical consideration and upon the implications of the disease or condition. A random UPCR screen positive threshold of 0.18 mg/dL maximizes sensitivity to identify clinically significant proteinuria. Key Points Random urine protein to creatinine ratio is a high performance test for proteinuria. A random UPCR threshold of 0.18 mg/dL maximizes sensitivity to identify proteinuria. Optimal test performance is dependent on the disease or clinical condition. [ABSTRACT FROM AUTHOR]

Published
2024
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8. Defining a Strategy for Laboratory Evaluation with Expectant Management of Preeclampsia.

Author

Cozzi, Gabriella D., Blanchard, Christina T., Sanjanwala, Aalok R., Page, Margaret R., Kim, Dhong-Jin, Tita, Alan T., Szychowski, Jeff M., and Subramaniam, Akila

Subjects
PREECLAMPSIA diagnosis, CLASSIFICATION, LOG-rank test, PATIENTS, RETROSPECTIVE studies, PREECLAMPSIA, KAPLAN-Meier estimator, LOGISTIC regression analysis, WOMEN'S health, LONGITUDINAL method
Abstract

Objective The objective of this study was to compare the frequency and timing of laboratory abnormalities and evaluate optimal laboratory testing strategies in women with preeclampsia (PE) undergoing expectant management. Study Design Retrospective cohort study of women with inpatient expectant management of PE at ≥23 weeks at a tertiary center from 2015 to 2018 was conducted. Women ineligible for expectant management or with less than two laboratory sets (platelets, aspartate aminotransferase, and serum creatinine) before the decision to deliver were excluded. Women were categorized as per the American College of Obstetricians and Gynecologists' definitions by initial diagnosis: PE without severe features, superimposed preeclampsia (SiPE) without severe features, and their forms with severe features. The frequency and timing of laboratory abnormalities were compared across the four PE categories. Kaplan–Meier curves modeled time to a laboratory abnormality (event) with censoring for delivery and were compared using log-rank tests. Logistic regression analysis modeled the development of a laboratory abnormality as a function of testing time intervals (days) for each PE type. Receiver operating characteristic curves and areas under the curve (AUC) were calculated; optimal cut points were determined using the Liu method. Results Among 636 women who met inclusion criteria, laboratory abnormalities were uncommon (6.3%). The median time to a laboratory abnormality among all women was ≤10 days, time being shortest in women with PE with severe features. Time to laboratory abnormality development did not differ significantly between the four PE groups (p = 0.36). Laboratory assessment intervals were most predictive for PE and SiPE with severe features (AUC = 0.87, AUC = 0.72). Optimal cutoffs were every 4 days for PE without severe features, 2 days for PE with severe features, 8 days for SiPE without severe features, and 3 days for SiPE with severe features. Conclusion Most laboratory abnormalities in PE occur earlier and more frequently in those with severe features. Individual phenotypes should undergo serial evaluation based on this risk stratification. Key Points Most laboratory abnormalities occur within 10 days of diagnosis. Laboratory abnormalities occur more often with severe features. Laboratory testing should occur according to disease severity. [ABSTRACT FROM AUTHOR]

Published
2023
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15. Evaluation of a Risk-Stratified, Heparin-Based, Obstetric Thromboprophylaxis Protocol

Author

Lu, Michelle Y., primary, Blanchard, Christina T., additional, Ausbeck, Elizabeth B., additional, Oglesby, Kacie R., additional, Page, Margaret R., additional, Lazenby, Allison J., additional, Cozzi, Gabriella D., additional, Muñoz Rogers, Rodrigo D., additional, Bushman, Elisa T., additional, Kaplan, Elle R., additional, Ruzic, Martha F., additional, Mahalingam, Mythreyi, additional, Dunk, Sarah, additional, Champion, Macie, additional, Casey, Brian M., additional, Tita, Alan T., additional, Kim, Dhong-Jin, additional, Szychowski, Jeff M., additional, and Subramaniam, Akila, additional

Published
2021
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16. 764 Operative vaginal delivery as an independent risk factor for maternal postpartum infection

Author

Dunk, Sarah A., primary, Owen, John, additional, Lu, Michelle Y., additional, Blanchard, Christina T., additional, Oglesby, Kacie R., additional, Page, Margaret R., additional, Lazenby, Allison J., additional, Ausbeck, Elizabeth B., additional, Cozzi, Gabriella D., additional, Muñoz Rogers, Rodrigo D., additional, Bushman, Elisa T., additional, Kaplan, Elle R., additional, Ruzic, Martha F., additional, Mahalingham, Mythreyi, additional, Champion, Macie L., additional, Casey, Brian M., additional, Tita, Alan, additional, Kim, Dhong-Jin, additional, Szychowski, Jeff M., additional, and Subramaniam, Akila, additional

Published
2021
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17. 557 Pregnancy outcomes associated with pragmatic use of aspirin at a single tertiary care center

Author

Champion, Macie L., primary, Blanchard, Christina T., additional, Oglesby, Kacie R., additional, Page, Margaret R., additional, Allison, Lazenby, additional, Ausbeck, Elizabeth B., additional, Cozzi, Gabriella D., additional, Rogers, Rodrigo Munoz, additional, Bushman, Elisa T., additional, Kaplan, Elle R., additional, Ruzic, Martha F., additional, Mahalingam, Mythreyi, additional, Dunk, Sarah A., additional, Casey, Brian M., additional, Tita, Alan, additional, Kim, Dhong-Jin, additional, Szychowski, Jeff M., additional, Lu, Michelle Y., additional, and Subramaniam, Akila, additional

Published
2021
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18. 358 VTE timing with routine heparin-based anticoagulation for inpatient obstetric thromboprophylaxis

Author

Lu, Michelle Y., primary, Blanchard, Christina T., additional, Oglesby, Kacie R., additional, Page, Margaret R., additional, Lazenby, Allison J., additional, Ausbeck, Elizabeth B., additional, Cozzi, Gabriella D., additional, Muñoz Rogers, Rodrigo D.D., additional, Bushman, Elisa T., additional, Kaplan, Elle R., additional, Ruzic, Martha F., additional, Mahalingam, Mythreyi, additional, Dunk, Sarah A., additional, Champion, Macie L., additional, Casey, Brian M., additional, Tita, Alan, additional, Kim, Dhong-Jin, additional, Szychowski, Jeff M., additional, and Subramaniam, Akila, additional

Published
2021
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19. 794 Venous thromboembolism and adverse outcomes in highest-VTE risk gravidas compared to those at lower risk

Author

Page, Margaret R., primary, Blanchard, Christina T., additional, Lu, Michelle Y., additional, Subramaniam, Akila, additional, Oglesby, Kacie R., additional, Ausbeck, Elizabeth B., additional, Cozzi, Gabriella D., additional, Rogers, Rodrigo Munoz, additional, Bushman, Elisa T., additional, Kaplan, Elle R., additional, Ruzic, Martha F., additional, Mahalingam, Mythreyi, additional, Dunk, Sarah A., additional, Champion, Macie L., additional, Kim, Dhong-Jin, additional, Szychowski, Jeff M., additional, Tita, Alan, additional, and Casey, Brian M., additional

Published
2021
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20. 59 Safety and efficacy of a risk-based obstetric heparin-based thromboprophylaxis regimen

Author

Lu, Michelle Y., primary, Blanchard, Christina T., additional, Oglesby, Kacie R., additional, Page, Margaret R., additional, Lazenby, Allison J., additional, Ausbeck, Elizabeth B., additional, Cozzi, Gabriella D., additional, Muñoz Rogers, Rodrigo D.D., additional, Bushman, Elisa T., additional, Kaplan, Elle R., additional, Ruzic, Martha F., additional, Mahalingam, Mythreyi, additional, Dunk, Sarah A., additional, Champion, Macie L., additional, Casey, Brian M., additional, Tita, Alan, additional, Kim, Dhong-Jin, additional, Szychowski, Jeff M., additional, and Subramaniam, Akila, additional

Published
2021
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21. 274 Healthcare resource utilization associated with a risk-based thromboprophylaxis protocol in obstetric patients

Author

Lazenby, Allison J., primary, Blanchard, Christina T., additional, Lu, Michelle Y., additional, Oglesby, Kacie R., additional, Page, Margaret R., additional, Ausbeck, Elizabeth B., additional, Cozzi, Gabriella D., additional, Muñoz Rogers, Rodrigo D.D., additional, Bushman, Elisa T., additional, Kaplan, Elle R., additional, Ruzic, Martha F., additional, Mahalingam, Mythreyi, additional, Dunk, Sarah A., additional, Champion, Macie L., additional, Casey, Brian M., additional, Tita, Alan, additional, Kim, Dhong-Jin, additional, Szychowski, Jeff M., additional, and Subramaniam, Akila, additional

Published
2021
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22. 510 Contemporary trends in cesarean delivery rates and indications

Author

Jaber, Sara, primary, Blanchard, Christina T., additional, Lu, Michelle Y., additional, Oglesby, Kacie R., additional, Page, Margaret R., additional, Lazenby, Allison J., additional, Ausbeck, Elizabeth B., additional, Cozzi, Gabriella D., additional, Muñoz Rogers, Rodrigo D.D., additional, Bushman, Elisa T., additional, Kaplan, Elle R., additional, Ruzic, Martha F., additional, Mahalingam, Mythreyi, additional, Dunk, Sarah A., additional, Champion, Macie L., additional, Casey, Brian M., additional, Tita, Alan, additional, Kim, Dhong-Jin, additional, Szychowski, Jeff M., additional, and Subramaniam, Akila, additional

Published
2021
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23. 582 Post-cesarean infections before and after implementation of adjunctive azithromycin in addition to standard antibiotics

Author

Ruzic, Martha F., primary, Blanchard, Christina T., additional, Robbins, Lindsay S., additional, Lu, Michelle Y., additional, Oglesby, Kacie R., additional, Page, Margaret R., additional, Ausbeck, Elizabeth B., additional, Cozzi, Gabriella D., additional, Bushman, Elisa T., additional, Mahalingam, Mythreyi, additional, Dunk, Sarah A., additional, Champion, Macie L., additional, Casey, Brian M., additional, Lazenby, Allison J., additional, Muñoz Rogers, Rodrigo D.D., additional, Tita, Alan, additional, Szychowski, Jeff M., additional, Kim, Dhong-Jin, additional, and Subramaniam, Akila, additional

Published
2021
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24. 390: Impact of a risk-based thromboprophylaxis protocol on postpartum bleeding and healthcare resource utilization

Author

Lu, Michelle Y., primary, Ausbeck, Elizabeth B., additional, Jauk, Victoria C., additional, Oglesby, Kacie R., additional, Muñoz, Rodrigo D., additional, Lazenby, Allison J., additional, Page, Margaret R., additional, Kim, Dhong-Jin, additional, Casey, Brian M., additional, Harper, Lorie M., additional, Tita, Alan T., additional, Szychowski, Jeff M., additional, and Subramaniam, Akila, additional

Published
2020
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28. 251: Accuracy of colorimetric quantitative blood loss estimation for identification of postpartum hemorrhage

Author

Pasko, Daniel N., primary, Jauk, Victoria C., additional, Steele, Robin, additional, Kim, Dhong-Jin, additional, Neely, Cherry, additional, Williams, Margaret A., additional, Tubinis, Michelle D., additional, Powell, Mark F., additional, Szychowski, Jeff M., additional, Casey, Brian M., additional, Tita, Alan T., additional, and Harper, Lorie M., additional

Published
2019
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31. Contemporary Trends in Cesarean Delivery Rates and Indications.

Author

Jaber S, Blanchard CT, Lu MY, Cozzi GD, Casey BM, Tita AT, Kim DJ, Szychowski JM, and Subramaniam A

Subjects
Humans, Female, Pregnancy, Retrospective Studies, Adult, Parity, Practice Guidelines as Topic, Tertiary Care Centers, Cesarean Section statistics & numerical data, Cesarean Section trends
Abstract

Objective: This study aimed to describe cesarean delivery rates and indications at a single center in order to assess the impact of the guidelines published by the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine on trends in labor management., Study Design: This is a retrospective cohort study of patients ≥23 weeks' gestation delivering at a single tertiary care referral center from 2013 to 2018. Demographic characteristics, mode of delivery, and main indication for cesarean delivery were ascertained by individual chart review. Cesarean delivery indications (mutually exclusive) were the following: repeat cesarean delivery, nonreassuring fetal status, malpresentation, maternal indications (e.g., placenta previa or genital herpes simplex virus), failed labor (any stage labor arrest), or other (i.e., fetal anomaly and elective). Polynomial (cubic) regression models were used to model rates of cesarean delivery and indications over time. Subgroup analyses further examined trends in nulliparous women., Results: Of the 24,637 patients delivered during the study period, 24,050 were included in the analysis; 7,835 (32.6%) had a cesarean delivery. The rates of overall cesarean delivery were significantly different over time ( p  < 0.001), declining to a minimum of 30.9% in 2014 and peaking at 34.6% in 2018. With regard to the overall cesarean delivery indications, there were no significant differences over time. When limited to nulliparous patients, the rates of cesarean delivery were also noted to be significantly different over time ( p  = 0.02) nadiring at 30% in 2015 from 35.4% in 2013 and then rising up to 33.9% in 2018. As for nulliparous patients, there was no significant difference in primary cesarean delivery indications over time except for nonreassuring fetal status ( p  = 0.049)., Conclusion: Despite changes in labor management definitions and guidelines encouraging vaginal birth, the rates of overall cesarean delivery did not decrease over time. The indications for delivery, particularly failed labor, repeat cesarean delivery, and malpresentation have not significantly changed over time., Key Points: · The rates of overall cesarean deliveries did not decrease despite the 2014 published recommendations for the reduction in cesarean deliveries.. · There were no significant differences in the indications of cesarean deliveries among nulliparous or multiparous women.. · Despite the adoption of strategies to reduce the overall and primary cesarean delivery rates, these trends remain unchanged.. · Indications for delivery, particularly failed labor, repeat cesarean delivery, and malpresentation have also not significantly changed over time.. · Additional strategies to encourage and increase vaginal delivery rates must be adopted.., Competing Interests: None declared., (Thieme. All rights reserved.)

Published
2024
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