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Meta-Analysis
. 2022 Jun 4;13(1):26.
doi: 10.1186/s13293-022-00436-0.

The diagnostic potential of oxidative stress biomarkers for preeclampsia: systematic review and meta-analysis

Dinara Afrose  1 , Hao Chen  1   2 , Amali Ranashinghe  3 , Chia-Chi Liu  4   5 , Annemarie Henessy  4   5   6 , Philip M Hansbro  1   2 , Lana McClements  7
Affiliations
Meta-Analysis

The diagnostic potential of oxidative stress biomarkers for preeclampsia: systematic review and meta-analysis

Dinara Afrose et al. Biol Sex Differ. .

Abstract

Background: Preeclampsia is a multifactorial cardiovascular disorder of pregnancy. If left untreated, it can lead to severe maternal and fetal outcomes. Hence, timely diagnosis and management of preeclampsia are extremely important. Biomarkers of oxidative stress are associated with the pathogenesis of preeclampsia and therefore could be indicative of evolving preeclampsia and utilized for timely diagnosis. In this study, we conducted a systematic review and meta-analysis to determine the most reliable oxidative stress biomarkers in preeclampsia, based on their diagnostic sensitivities and specificities as well as their positive and negative predictive values.

Methods: A systematic search using PubMed, ScienceDirect, ResearchGate, and PLOS databases (1900 to March 2021) identified nine relevant studies including a total of 343 women with preeclampsia and 354 normotensive controls.

Results: Ischemia-modified albumin (IMA), uric acid (UA), and malondialdehyde (MDA) were associated with 3.38 (95% CI 2.23, 4.53), 3.05 (95% CI 2.39, 3.71), and 2.37 (95% CI 1.03, 3.70) odds ratios for preeclampsia diagnosis, respectively. The IMA showed the most promising diagnostic potential with the positive predictive ratio (PPV) of 0.852 (95% CI 0.728, 0.929) and negative predictive ratio (NPV) of 0.811 (95% CI 0.683, 0.890) for preeclampsia. Minor between-study heterogeneity was reported for these biomarkers (Higgins' I2 = 0-15.879%).

Conclusions: This systematic review and meta-analysis identified IMA, UA, and MDA as the most promising oxidative stress biomarkers associated with established preeclampsia. IMA as a biomarker of tissue damage exhibited the best diagnostic test accuracy. Thus, these oxidative stress biomarkers should be further explored in larger cohorts for preeclampsia diagnosis.

Keywords: Biomarkers; Heavy metals; IMA; MDA; Oxidative stress; Preeclampsia; Uric acid.

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Conflict of interest statement

“The authors declare that they have no competing interests” in this section.

Figures

Fig. 1
Fig. 1
Study design of meta-analysis. a Preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines flow diagram. b Risk of bias and applicability concerns summary. c Risk of bias and applicability concerns graphical presentation
Fig. 2
Fig. 2
Diagnostic evaluation of IMA in preeclampsia using the bivariate, random-effects model. a Forest plot of three independent studies investigating the diagnostic performance of IMA in preeclampsia, with sensitivity and specificity reported and ln(DOR). b Plot of HSROC curve showing the estimated pooled diagnostic accuracy
Fig. 3
Fig. 3
Diagnostic evaluation of UA in preeclampsia using the bivariate, random-effects model. a Forest plot of three independent studies investigating the diagnostic performance of UA in preeclampsia, with sensitivity and specificity, reported and ln(DOR). b Plot of HSROC curve showing the estimated pooled diagnostic accuracy
Fig. 4
Fig. 4
Diagnostic evaluation of MDA in preeclampsia using the bivariate, random-effects model. a Forest plot of three independent studies investigating the diagnostic performance of MDA in preeclampsia, with sensitivity and specificity reported and ln(DOR). b Plot of HSROC curve showing the estimated pooled diagnostic accuracy
See this image and copyright information in PMC

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