Point-of-Care Tests for Preeclampsia: Systematic Review and Meta-Analysis of Diagnostic Test Accuracy Studies

Background

Preeclampsia is a common condition associated with significant maternal and foetal complications. The diagnosis of preeclampsia is based on clinical criteria, with recent introduction of angiogenic markers as an aid to clinical triage. Several biomarkers are now available in a point-of-care test format, which provide swift results to support clinical decision-making.

Objectives

To determine sensitivity and specificity of available point-of-care tests used for preeclampsia prediction.

Search Strategy

Systematic searches of databases (PubMed/Medline, Ovid Embase) from inception till May 2024 were done to identify relevant studies. Selection criteria: we included studies reporting on the diagnostic test accuracy of any point-of-care test for short-term prediction of preeclampsia in the second or third trimester.

Data Collection and Analysis

Data were extracted using pre-designed template, and statistical analysis was performed to pool sensitivity and specificity and a hierarchal summary receiver operating characteristic curve model was used. Quality of included studies and risk of bias were assessed following the QUADAS-2 tool.

Main Results

We identified 17 studies that met the inclusion criteria, six of which described the use of glycosylated fibronectin, five with Congo red, two with placental growth factor (PlGF) and one study each investigated nephrin, misfolded protein, CD44/FKBPL ratio and inositol phosphoglycan-P. Meta-analysis was possible only for glycosylated fibronectin with a pooled sensitivity of 0.80 (95% CI: 0.51–0.94) and a specificity of 0.84 (95% CI: 0.71–0.93). Five studies were included in meta-analysis, all of which had a low risk of bias on the QUADAS assessment.

Conclusions

These findings suggest that the point-of-care glycosylated fibronectin testing might be beneficial in clinical triage for preeclampsia in an at-risk population.