CLINICAL UTILITY OF ADRENOMEDULLIN IN DIAGNOSIS OF PREECLAMPSIA

Abstract

PE is a potentially serious condition that still accounts for significant morbidity and mortality for the mother and the neonate. Although, the pathogenesis is not fully understood, it is now widely accepted that vascular endothelial dysfunction is the most astonishing and the principal event in the pathophysiology of the disease. The vascular theory, in which ischemia-reperfusion leads to oxidative stress and vascular disease, and there is also the immunological theory, which considers PE as a maternal-paternal immune mal-adaptation. This led us to designing a case-control study. Studying of serum levels of AM in 60 patients with PE (group I) further subdivided into mild PE (group Ia) (n=30) and severe PE (group Ib) (n=30). The control group (group II) (n=25) who were healthy normotensive age-matched pregnant females. All the studied individuals were subjected to full history taking and complete clinical examination. Blood samples were collected for determination of ALT, AST, BUN, creatinine, CBC, RBG, serum AM and urine protein estimation by dipstick test in a morning urine sample. Assay of serum AM was carried out using an enzyme linked immunosorbent assay technique. The results of the present study revealed a statistically highly significant increase (p < 0.01) in serum levels of AM in all groups of preeclamptic women (group Ia and group Ib) compared to their matched controls (group II). Also, there is a statistically highly significant increase (p < 0.01) in serum AM in group Ia when compared with group II alone and a statistically highly significant increase (p < 0.01) in serum AM in group Ib when compared with group II alone. Assessment of the diagnostic performance of serum AM in mild preclamptic patients versus the healthy control subjects using ROC curve analysis revealed that the best diagnostic cutoff level of AM was 4.5 ng/dl. At this cutoff, with a diagnostic sensitivity of 100 %, diagnostic specificity 92%, positive predictive value 93.8 %, negative predictive value 100%, diagnostic efficacy 96.4%. The diagnostic performance of AM was assessed to differentiate severe preeclamptic women from those with mild PE. It revealed that the best cutoff level was 13 ng/dl, with a diagnostic sensitivity of 80%, diagnostic specificity 87.3%, positive predictive value 77.4% negative predictive value 88.9%, diagnostic efficacy 84.7%. In conclusion, our study proved a significant role of AM in PE. Not only that, but we also proved correlation between the level of AM and the severity of PE.