Accuracy of serum uric acid in predicting complications of pre-eclampsia: a systematic review


Dr S Thangaratinam, Academic Unit of Obstetrics and Gynaecology, Maternity Block, University Hospital of North Staffordshire, Stoke-on-Trent, ST4 6QG, UK. Email


Background  Pre-eclampsia is one of the largest causes of maternal and fetal mortality and morbidity. Hyperuricemia is often associated with pre-eclampsia.

Objective  To determine the accuracy with which serum uric acid predicts maternal and fetal complications in women with pre-eclampsia.

Study design  Systematic quantitative review of test accuracy studies.

Search strategy  We conducted electronic searches in MEDLINE (1951–2004), EMBASE (1980–2004), the Cochrane Library (2004:4) and the MEDION database to identify relevant articles. A hand-search of selected specialist journals and reference lists of articles obtained was then carried out. There were no language restrictions for any of these searches.

Selection criteria  Two reviewers independently selected the articles in which the accuracy of serum uric acid was evaluated to predict maternal and fetal complications of pre-eclampsia.

Data collection and analysis  Data were extracted on study characteristics, quality and accuracy to construct 2 × 2 tables with maternal and fetal complications as reference standard. Summary likelihood ratios for positive (LR+) and negative LR(−) test results are generated for various threshold levels of uric acid.

Main results  There were 18 primary articles that met the selection criteria, including a total of 3913 women and forty-one 2 × 2 tables. In women with pre-eclampsia, a positive test result of uric acid greater than or equal to a 350-μmol/l threshold predicted eclampsia with a pooled likelihood ratio (LR) of 2.1 (95% CI 1.4–3.5), while a negative test result had a pooled LR of 0.38 (95% CI 0.18–0.81). For severe hypertension as the outcome measure, the LRs were 1.7 (95% CI 1.3–2.2) and 0.49 (95% CI 0.38–0.64) for positive and negative test results, respectively, and for caesarean section the LRs were 2.4 (95% CI 1.3–4.7) and 0.39 (95% CI 0.20–0.76). For stillbirths and neonatal deaths the respective LRs were 1.5 (95% CI 0.91–2.6) and 0.51 (95% CI 0.20–1.3). For the prediction of small-for-gestational-age fetus, the pooled LRs were 1.3 (95% CI 1.1–1.7) and 0.60 (95% CI 0.43–0.83) for positive and negative results, respectively.

Author's conclusion  Serum uric acid is a poor predictor of maternal and fetal complications in women with pre-eclampsia.