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Contemporary test performance of the random urine protein-to-creatinine ratio.

Objective The random urine protein-to-creatinine ratio (UPCR) is a screening test to predict clinically significant proteinuria (≥300mg) during pregnancy. No consensus exists on optimal random UPCR cutoff for performing follow-up 24-hour urine total protein (24H) collection. We evaluated the test performance of random UPCR ratio in predicting proteinuria in a contemporary cohort. Study Design This was a retrospective cohort study of pregnant patients at our institution from 2014 to 2018 with a random UPCR and follow-up 24H urine protein collection. Primary analysis estimated the test characteristics (sensitivity, specificity, PPV, NPV) of using UPCR for the detection of proteinuria. UPCR cutoffs from 0.10 to 0.30mg/dL were evaluated, ROC curve was constructed, and AUC was determined. A secondary analysis examined correlation between UPCR and 24H using least squares regression and Pearson correlation. Results Paired UPCR and 24H results were available for 1120 patients. Mean gestational age at time of UPCR was 31.1 ± 5.1 weeks, and 687 (61.3%) patients had a 24H 300mg. UPCR <0.10 mg/dL effectively excluded proteinuria 300mg on 24H collection. UPCR ≥0.18mg/dL correctly classifies proteinuria with 91% sensitivity, 57% specificity, 77% PPV, and 79% NPV. UPCR ≥1.07 mg/dL had 100% specificity for proteinuria. The AUC was 0.86. UPCR and 24H collection were highly correlated with a Pearson correlation coefficient of 0.85. After our institution lowered threshold to obtain a 24H from UPCR ≥0.20 mg/dL to ≥0.10 mg/dL in May 2017, the percentage of patients meeting criteria for 24 hour urine collection increased from 57.8% to 84.4%. Conclusion The AUC and Pearson correlation suggest random UPCR is a high performance test for the prediction of proteinuria. Optimal test performance is dependent upon clinical consideration and the implications of the disease or condition. A random UPCR screen positive threshold of 0.18 mg/dL maximizes sensitivity to identify clinically significant proteinuria.