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Background <p>Distinguishing early-onset preeclampsia (EO-PE) from gestational hypertension (GHT) at initial presentation remains challenging, particularly when classical diagnostic features are absent or evolving. We evaluated whether combining the albumin-adjusted ischemia-modified albumin ratio (IMAR) with uterine artery pulsatility index expressed as multiples of the median (UtA-PI MoM) provides complementary information in this setting.</p> Methods <p>In this prospective single-center exploratory study, 90 singleton pregnancies (30 EO-PE, 30 GHT, 30 controls) were included. IMAR and UtA-PI MoM were assessed individually and in combination using receiver operating characteristic analysis and logistic regression with bootstrap internal validation.</p> Results <p>IMAR and UtA-PI MoM were higher in EO-PE than in GHT (<i>p</i> = 0.003 and <i>p</i> &lt; 0.001, respectively), whereas raw IMA did not distinguish the groups. IMAR demonstrated moderate discrimination (AUC 0.727, 95% CI 0.600–0.854), and UtA-PI MoM demonstrated higher performance (AUC 0.844, 95% CI 0.743–0.946). The combined model showed the highest apparent discrimination (AUC 0.898, 95% CI 0.818–0.977; optimism-corrected AUC 0.889), with 83.3% sensitivity and 86.7% specificity at the exploratory operating point.</p> Conclusions <p>Combining IMAR with UtA-PI MoM may provide complementary information for distinguishing EO-PE from GHT at initial presentation. This exploratory model is not intended to replace established angiogenic biomarkers and requires validation in larger, multicenter studies before clinical application.</p>

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Combined albumin-adjusted ischemia-modified albumin ratio and uterine artery Doppler for differentiating early-onset preeclampsia from gestational hypertension: a prospective exploratory pilot study

  • 期刊论文

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  • 发表日期：

    2026年7月24日

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  • Serkan Özbey,
  • Handan Turhan Karakuş,
  • Alper Gümüş,
  • Pakizer Banu Kılıçoğlu Dane

摘要

Background

Distinguishing early-onset preeclampsia (EO-PE) from gestational hypertension (GHT) at initial presentation remains challenging, particularly when classical diagnostic features are absent or evolving. We evaluated whether combining the albumin-adjusted ischemia-modified albumin ratio (IMAR) with uterine artery pulsatility index expressed as multiples of the median (UtA-PI MoM) provides complementary information in this setting.

Methods

In this prospective single-center exploratory study, 90 singleton pregnancies (30 EO-PE, 30 GHT, 30 controls) were included. IMAR and UtA-PI MoM were assessed individually and in combination using receiver operating characteristic analysis and logistic regression with bootstrap internal validation.

Results

IMAR and UtA-PI MoM were higher in EO-PE than in GHT (p = 0.003 and p < 0.001, respectively), whereas raw IMA did not distinguish the groups. IMAR demonstrated moderate discrimination (AUC 0.727, 95% CI 0.600–0.854), and UtA-PI MoM demonstrated higher performance (AUC 0.844, 95% CI 0.743–0.946). The combined model showed the highest apparent discrimination (AUC 0.898, 95% CI 0.818–0.977; optimism-corrected AUC 0.889), with 83.3% sensitivity and 86.7% specificity at the exploratory operating point.

Conclusions

Combining IMAR with UtA-PI MoM may provide complementary information for distinguishing EO-PE from GHT at initial presentation. This exploratory model is not intended to replace established angiogenic biomarkers and requires validation in larger, multicenter studies before clinical application.