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Am J Obstet Gynecol. 2003 Sep;189(3):848-52.

A prospective comparison of total protein/creatinine ratio versus 24-hour urine protein in women with suspected preeclampsia.

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  • 1Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.



The purpose of this study was to determine the value of the protein/creatinine ratio in prediction of 24-hour urine total protein among women with suspected preeclampsia.


Women who were evaluated for suspected preeclampsia at >or=24 weeks of gestation were studied prospectively if there was no concurrent diagnosis of chronic hypertension, diabetes mellitus, or preexisting renal disease. A protein/creatinine ratio was obtained, which was followed by the initiation of a 24-hour urine evaluation. Positive and negative predictive values and sensitivity and specificity of the protein/creatinine ratio for significant (>or=300 mg) and severe proteinuria (>or=5000 mg) that were based on 24-hour urine total protein were calculated.


A total of 220 women were evaluated; 43.2% of the women were black, and 80% of the women had government insurance. Mean maternal and gestational ages were 26.1 years and 36.5 weeks, respectively. Significant and severe proteinuria on 24-hour urine evaluation were identified in 76.4% and 8.2% of cases, respectively. Regression analysis of protein/creatinine ratio and 24-hour urine total protein level showed a poor correlation (r(2)=0.41). Receiver operator characteristic analysis revealed an area under the curve of 0.80, but the shoulder value of 390 mg/g carried a high false-negative rate (45.2%). With a more conservative cutoff value, a protein/creatinine ratio of >or=300 mg/g had a poor negative predictive value (47.5%), a specificity for significant proteinuria (55.8%), with a positive predictive value of 85.5%, and a sensitivity of 81%. For severe proteinuria, a protein/creatinine ratio of >or=5000 mg/g had a poor positive predictive value (61.9%) and sensitivity (72.2%), with a negative predictive value of 97.5%, and a specificity of 96.0%.


Protein/creatinine ratio does not exclude adequately the presence of significant proteinuria or predict severe proteinuria and should not be used as an alternative to 24-hour total protein evaluation.

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