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Utility of Urinary Protein‐Creatinine Ratio and Protein Content in a 24‐Hour Urine Collection in Systemic Lupus Erythematosus: A Systematic Review and Meta‐Analysis
Author(s) -
MedinaRosas Jorge,
Yap Kristy S.,
Anderson Melanie,
Su Jiandong,
Touma Zahi
Publication year - 2016
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.22828
Subject(s) - medicine , intraclass correlation , concordance , proteinuria , creatinine , meta analysis , concordance correlation coefficient , kappa , urine , urinary system , gold standard (test) , gastroenterology , kidney , psychometrics , statistics , clinical psychology , linguistics , philosophy , mathematics
Objective To systematically review literature on the utility of spot urinary protein‐creatinine ratio (PCR) as a screening test for proteinuria and its ability to accurately measure proteinuria compared with 24‐hour urine collection (24H‐P) in patients with systemic lupus erythematosus (SLE). Methods We conducted a literature search (1900–2015) for articles comparing PCR and 24H‐P in SLE patients in the databases Medline, Web of Science, and Embase. Included studies and their results were critically appraised and analyzed. Results Thirteen studies (1,001 patients; 84.01% women) were included. Ten studies reported on Pearson's correlation (range 0.67–0.94), and 3 studies reported on Spearman's correlation (range 0.78–1.00). The meta‐analysis of studies with Pearson's correlation showed a high overall correlation of 0.80 between 24H‐P and PCR, yet with high heterogeneity (I 2 = 97.2%). Correlation analysis is not sufficient to evaluate the utility of a new test against the gold standard test, and analysis on agreement is required. Seven studies reported on agreement: 3 studies analyzed concordance correlation coefficient (0.48–0.94), 3 analyzed intraclass correlation coefficient (0.66–0.95), and 1 analyzed kappa coefficient (0.58). These results confirmed that the agreement between 24H‐P and PCR was inappropriate. Three studies included Bland‐Altman plots, and the results also demonstrated poor agreement between both tests. Conclusion The PCR has a utility as a screening test for proteinuria in SLE patients. The studies' results of 24H‐P and PCR showed poor agreement between both tests, signifying that PCR should not be a substitute for the gold standard test (24H‐P) to accurately measure proteinuria.