Third Dpt of Obstetrics and Gynecology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece.
First Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Greece.
Pregnancy Hypertens. 2019 Apr;16:97-104. doi: 10.1016/j.preghy.2019.03.006. Epub 2019 Mar 11.
Serum cystatin-c is a protein that is filtered freely through the glomerulus and reabsorbed and degraded by proximal tubular cells and can be used as a biomarker of renal function. Its levels rise during the third trimester and decrease in the postpartum period. The purpose of the present meta-analysis is to assess the performance of serum cystatin-c for the prediction of preeclampsia.
We used the Medline, Scopus, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL and Google Scholar. We selected all observational studies (both prospective and retrospective) that investigated the accuracy of cystatin-c in predicting preeclampsia. Statistical meta-analysis was performed with the RevMan 5.3 and Stata/IC 13.0 software, using hierarchical models to develop the SROC curve.
The quantitative synthesis was based in 27 studies with a total number of 2,320 women. Serum cystatin-c levels were higher in preeclamptic women compared to healthy pregnant controls (MD: 0.40 mg/l, 95% CI [0.33, 0.46]). The pooled sensitivity of serum cystatin-c for the prediction of preeclampsia was 0.85 (95% CI [0.79-0.89]) and the pooled specificity 0.84 (95% CI [0.77-0.90]. Fagan's nomogram indicated that the post-test probability increased to 14% (positive test) and decreased to 1% (negative test), when the pre-test probability was set at 3%.
According to the findings of our study serum cystatin-c seems to be a promising biomarker for the detection of preeclampsia during the third trimester of pregnancy. Therefore, its implementation in future predictive models in the field is recommended.
血清胱抑素 C 是一种可自由通过肾小球滤过、被近端肾小管细胞重吸收和降解的蛋白质，可作为肾功能的生物标志物。其水平在妊娠晚期升高，在产后期间下降。本荟萃分析的目的是评估血清胱抑素 C 预测子痫前期的性能。
我们使用了 Medline、Scopus、Clinicaltrials.gov、EMBASE、Cochrane 中央对照试验注册中心 CENTRAL 和 Google Scholar。我们选择了所有研究血清胱抑素 C 预测子痫前期准确性的观察性研究（前瞻性和回顾性）。使用 RevMan 5.3 和 Stata/IC 13.0 软件进行统计荟萃分析，使用层次模型绘制 SROC 曲线。
定量综合基于 27 项研究，共纳入 2320 名女性。与健康孕妇对照组相比，子痫前期女性的血清胱抑素 C 水平更高（MD：0.40mg/l，95%CI [0.33, 0.46]）。血清胱抑素 C 预测子痫前期的总敏感性为 0.85（95%CI [0.79-0.89]），总特异性为 0.84（95%CI [0.77-0.90]）。Fagan 列线图表明，当预测试验概率设定为 3%时，阳性试验的后测概率增加到 14%（阳性试验），阴性试验的后测概率降低到 1%。
根据我们的研究结果，血清胱抑素 C 似乎是检测妊娠晚期子痫前期的一种很有前途的生物标志物。因此，建议在该领域的未来预测模型中实施。
