Avaliação de marcadores clínicos e urinários da preeclampsia em gestações de risco: uma análise longitudinal

Abstract

Preeclâmpsia ( PE ) is the leading cause of maternal and fetal morbidity and mortality , affecting 5-7 % of pregnant women in the world . The search for early diagnosis using minimally invasive methods with good accuracy seeks to prevent maternal and fetal complications. Objective: To evaluate the predictive avoid of clinical and biochemical markers for early diagnosis of PE. Patients and methods: a cohort longitudinal study of 139 patients recruited early and followed until delivery. Clinical data and urine samples were collected for measurement of proteinúria, creatinine, PlGF and sFlit-1, levels during pregnancy. The association with hypertension was estimated by the ratio of univariate and multivariate odds , as well as accuracy of clinical and epidemiological risk and measured biochemical factors in predicting PE. Results: thirty-eight ( 27.3 %) pregnant women had some hypertensive syndrome at birth , these 26 ( 68.4 %) developed PE. Recruitment, patients who would develop PE in childbirth , had a gestational age 12.1 ± 3.4 weeks and systolic blood pressure ( 150 ± 15,4mmHg ) and diastolic ( 99 ± 10,6mmHg ) , higher than in the control group (systolic blood pressure (109±9,8 mmHg) and diastolic (68±7,6mmHg) (p < 0.001). Risk factors associated isolated with hypertensive syndrome were: a history of PE (OR 13.2 , 95% CI : 2.7-65.5) , age > 35 years ( OR 3.6 , 95% CI : 1,1-11.4 ) and the IMC30Kg / m2 in recruitment (OR : 3.30 , 95% CI 1.2-8.8 ) . For PE , the clinical and biochemical predictors corrected by cofactors were: previous history of PE (OR 14.4 , 95% CI : 0.8-279.0 ) , the IMC30Kg / m2 in recruitment (OR : 4.80 95% CI 0.9 to 25.5 ) , be primigravida (OR 5.60 , 95% CI : 1.30-24.6 ), and elevated concentration of urinary creatinine (mg/dL) , measured at recruitment (OR 1.01 , 95% CI : 1.01-1.03). Conclusion: Urinary biochemical markers studied (proteinúria, creatinine, PLGF and Sflit-1) showed different behavior in relation to the predictive ability of PE, and only, urinary creatinine showed biochemical clinical value for use in combination with clinical predictors in pregnant women at risk .