Waugh Jason J S, Clark T Justin, Divakaran T G, Khan Khalid S, Kilby Mark D
Department of Obstetrics and Gynecology, Leicester Warwick Medical School, University of Leicester, Leicester, United Kingdom.
Obstet Gynecol. 2004 Apr;103(4):769-77. doi: 10.1097/01.AOG.0000118311.18958.63.
To estimate the accuracy of point-of-care dipstick urinalysis in predicting significant proteinuria in pregnancy.
Literature from 1970 to February 2002 was identified via 1). general bibliographic databases, that is, MEDLINE and EMBASE, 2). Cochrane Library and relevant specialist register of the Cochrane Collaboration, and 3). checking the reference lists of known primary and review articles.
Studies were selected if the accuracy of dipstick urinalysis techniques in predicting total protein excretion was estimated compared with a reference standard (laboratory estimation of protein excretion). The tests included visually read color-change dipsticks and automated dipstick urinalysis. Study selection, quality assessment, and data abstraction were performed independently and in duplicate.
TABULATION, INTEGRATION, AND RESULTS: Data from selected studies were abstracted as 2 x 2 tables comparing the test result with the reference standard. Test accuracy was expressed as likelihood ratios. Summary likelihood ratios were generated as measures of diagnostic accuracy to determine posttest probabilities. The electronic search produced 1543 citations. After independent review of published articles, a total of 34 articles was obtained for further scrutiny, and 7 studies were considered eligible for inclusion in the review. The 6 studies evaluating visual dipstick urinalysis produced a pooled positive likelihood ratio of 3.48 (95% confidence interval 1.66, 7.27) and a pooled negative likelihood ratio of 0.6 (95% confidence interval 0.45, 0.8) for predicting 300 mg/24-hour proteinuria at the 1+ or greater threshold.
The accuracy of dipstick urinalysis with a 1+ threshold in the prediction of significant proteinuria is poor and therefore of limited usefulness to the clinician. Accuracy may be improved at higher thresholds (greater than 1+ proteinuria), but available data are sparse and of poor methodological quality. Therefore, it is not possible to make meaningful inferences about accuracy at higher urine dipstick thresholds. There is an urgent need for research in this area of common obstetric practice.
评估即时检验尿试纸法在预测妊娠期间显著蛋白尿方面的准确性。
通过以下方式确定1970年至2002年2月的文献：1）一般文献数据库，即MEDLINE和EMBASE；2）Cochrane图书馆及Cochrane协作网的相关专业注册库；3）查阅已知的原始文献和综述文章的参考文献列表。
若评估了尿试纸法技术在预测总蛋白排泄方面的准确性，并与参考标准（实验室对蛋白排泄的估计）进行比较，则选择该研究。测试包括目视读取变色尿试纸和自动尿试纸分析。研究选择、质量评估和数据提取均独立进行且重复两次。
制表、整合与结果：将所选研究的数据提取为2×2表格，比较测试结果与参考标准。测试准确性以似然比表示。生成汇总似然比作为诊断准确性的度量，以确定验后概率。电子检索产生1543条引文。在对已发表文章进行独立评审后，共获得34篇文章以供进一步审查，7项研究被认为符合纳入综述的条件。评估目视尿试纸分析的6项研究在预测1+或更高阈值下24小时蛋白尿300mg时，汇总阳性似然比为3.48（95%置信区间1.66, 7.27），汇总阴性似然比为0.6（95%置信区间0.45, 0.8）。
尿试纸法以1+阈值预测显著蛋白尿的准确性较差，因此对临床医生的实用性有限。在更高阈值（大于1+蛋白尿）时准确性可能会提高，但现有数据稀少且方法学质量较差。因此，无法对更高尿试纸阈值下的准确性做出有意义的推断。在这一常见产科实践领域迫切需要开展研究。
