Association between urinary neutrophil gelatinase-associated lipocalin and severe preeclampsia among pregnant women in Kinshasa: a multicenter-based cross-sectional study.

backgroundPreeclampsia (PE) is a multisystem and hypertensive disorder that disproportionately affects pregnant women after 20 weeks of gestation. Neutrophil gelatinase-associated lipocalin (NGAL) is crucial for the diagnosis of PE. In other settings, research highlights an association between urinary NGAL and severe PE. No studies have focused on this association in the Democratic Republic of the Congo, specifically in Kinshasa, which bears the highest number of women with PE in the country. This study aimed to assess the association between urinary NGAL and severe PE, as well as the discriminatory ability of urinary NGAL between moderate and severe PE among pregnant women in Kinshasa.

methodsWe conducted a multicenter hospital-based cross-sectional survey among 197 pregnant women using a convenience sampling approach in Kinshasa. We collected sociodemographic, clinical, and biological data. Urinary NGAL levels were measured and classified as normal (< 131.7 ng/mL) or high (≥ 131.7 ng/mL). A receiver operating characteristic curve was generated to assess the discriminative ability of urinary NGAL between moderate and severe PE. Modified Poisson regression with robust standard errors was performed to examine the association between urinary NGAL and severe PE.

resultsOverall, 45.2% (89) of women had high urinary NGAL levels. A history of diabetes mellitus was significantly associated with elevated NGAL levels (19.1% vs. 14.8%; p = 0.044). More than Eclampsia was the most common maternal complication among women with PE (14.2%). Intrauterine fetal death was the most common fetal complication in fetuses whose mothers had PE. No significant difference was found in urinary NGAL levels between women with moderate PE and those with severe PE (p = 0.432). Urinary NGAL had poor discriminatory performance, with an area under the curve of 0.57. High urinary NGAL level was not associated with severe PE ([aPR = 1.29; 95% CI (0.99–1.67)]; p = 0.056).

conclusionThis study reveals no association between urinary NGAL severe PE, a poor ability of urinary NGAL to discriminate between moderate and severe PE among pregnant women in Kinshasa. Larger cross-sectional surveys using probabilistic sampling approaches and longitudinal cohort studies are needed to assess the discriminatory ability and predictive value for whether discriminating moderate and severe urinary NGAL and predicting progression to severe PE and maternal–fetal outcomes and to establish appropriate NGAL cutoff values for African populations.