Role of day 4 HCG as an early predictor of success after methotrexate therapy for ectopic pregnancies

S. Girija, A. P. Manjunath, A. Salahudin, L. Jeyaseelan, V. Gowri, A. Abu-Heija, L. Al Kharusi

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objective To validate whether change in serum HCG levels between days 0 and 4 confer any prognostic value during methotrexate therapy and to quantify its change. Study design This is a retrospective study of 48 tubal ectopic pregnancies treated with single dose methotrexate protocol at University Hospital, Muscat, Oman from January 2012 to December 2013. The clinical outcome was analyzed based on the complete resolution of HCG levels or need for additional doses of methotrexate or recourse to surgery. The percentage change in HCG levels between days 0 and 4 (HCG index) of methotrexate were calculated and receiver operator characteristics curve was plotted to identify the best cutoff levels. In order to get a robust 95% confidence interval, bootstrap method using R software was done using 1000 re-sampling. ROC curve and the predictive values were estimated using MEDCALC software. Results The mean HCG level on day 4 is significantly higher in treatment failure group (4254 ± 4095 IU/L vs. 2109 ± 3646 IU/L, P = 0.008). The HCG levels between day 0 and 4 decreased in 42.7% (21/48) of cases and 80.9% of these cases had treatment success. The HCG levels increased in 57.4% (27/48) of cases and 33.3% of these cases had treatment success. (P = 0.001). A 10 percent decline in day 4 HCG levels predict the treatment success with sensitivity of 77% and Specificity 81%. The area under the ROC curve was 0.82 (95% CI: 0.67–0.92), (P < 0.001). Conclusion The success with single dose of methotrexate therapy for tubal ectopic pregnancies was predicted early in the course of treatment by following three key findings: the absolute mean HCG values on day 4, decrease in HCG level from day 0 to 4 and 10% or more fall in day 4 HCG levels.

Original languageEnglish
Pages (from-to)230-233
Number of pages4
JournalEuropean Journal of Obstetrics Gynecology and Reproductive Biology
Volume215
DOIs
Publication statusPublished - Aug 1 2017

Fingerprint

Ectopic Pregnancy
Methotrexate
Tubal Pregnancy
ROC Curve
Software
Oman
Therapeutics
Treatment Failure
Area Under Curve
Retrospective Studies
Confidence Intervals
Sensitivity and Specificity
Serum

Keywords

  • Ectopic pregnancy
  • HCG
  • Medical management
  • Methotrexate

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynaecology

Cite this

Role of day 4 HCG as an early predictor of success after methotrexate therapy for ectopic pregnancies. / Girija, S.; Manjunath, A. P.; Salahudin, A.; Jeyaseelan, L.; Gowri, V.; Abu-Heija, A.; Al Kharusi, L.

In: European Journal of Obstetrics Gynecology and Reproductive Biology, Vol. 215, 01.08.2017, p. 230-233.

Research output: Contribution to journalArticle

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abstract = "Objective To validate whether change in serum HCG levels between days 0 and 4 confer any prognostic value during methotrexate therapy and to quantify its change. Study design This is a retrospective study of 48 tubal ectopic pregnancies treated with single dose methotrexate protocol at University Hospital, Muscat, Oman from January 2012 to December 2013. The clinical outcome was analyzed based on the complete resolution of HCG levels or need for additional doses of methotrexate or recourse to surgery. The percentage change in HCG levels between days 0 and 4 (HCG index) of methotrexate were calculated and receiver operator characteristics curve was plotted to identify the best cutoff levels. In order to get a robust 95{\%} confidence interval, bootstrap method using R software was done using 1000 re-sampling. ROC curve and the predictive values were estimated using MEDCALC software. Results The mean HCG level on day 4 is significantly higher in treatment failure group (4254 ± 4095 IU/L vs. 2109 ± 3646 IU/L, P = 0.008). The HCG levels between day 0 and 4 decreased in 42.7{\%} (21/48) of cases and 80.9{\%} of these cases had treatment success. The HCG levels increased in 57.4{\%} (27/48) of cases and 33.3{\%} of these cases had treatment success. (P = 0.001). A 10 percent decline in day 4 HCG levels predict the treatment success with sensitivity of 77{\%} and Specificity 81{\%}. The area under the ROC curve was 0.82 (95{\%} CI: 0.67–0.92), (P < 0.001). Conclusion The success with single dose of methotrexate therapy for tubal ectopic pregnancies was predicted early in the course of treatment by following three key findings: the absolute mean HCG values on day 4, decrease in HCG level from day 0 to 4 and 10{\%} or more fall in day 4 HCG levels.",
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AU - Girija, S.

AU - Manjunath, A. P.

AU - Salahudin, A.

AU - Jeyaseelan, L.

AU - Gowri, V.

AU - Abu-Heija, A.

AU - Al Kharusi, L.

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N2 - Objective To validate whether change in serum HCG levels between days 0 and 4 confer any prognostic value during methotrexate therapy and to quantify its change. Study design This is a retrospective study of 48 tubal ectopic pregnancies treated with single dose methotrexate protocol at University Hospital, Muscat, Oman from January 2012 to December 2013. The clinical outcome was analyzed based on the complete resolution of HCG levels or need for additional doses of methotrexate or recourse to surgery. The percentage change in HCG levels between days 0 and 4 (HCG index) of methotrexate were calculated and receiver operator characteristics curve was plotted to identify the best cutoff levels. In order to get a robust 95% confidence interval, bootstrap method using R software was done using 1000 re-sampling. ROC curve and the predictive values were estimated using MEDCALC software. Results The mean HCG level on day 4 is significantly higher in treatment failure group (4254 ± 4095 IU/L vs. 2109 ± 3646 IU/L, P = 0.008). The HCG levels between day 0 and 4 decreased in 42.7% (21/48) of cases and 80.9% of these cases had treatment success. The HCG levels increased in 57.4% (27/48) of cases and 33.3% of these cases had treatment success. (P = 0.001). A 10 percent decline in day 4 HCG levels predict the treatment success with sensitivity of 77% and Specificity 81%. The area under the ROC curve was 0.82 (95% CI: 0.67–0.92), (P < 0.001). Conclusion The success with single dose of methotrexate therapy for tubal ectopic pregnancies was predicted early in the course of treatment by following three key findings: the absolute mean HCG values on day 4, decrease in HCG level from day 0 to 4 and 10% or more fall in day 4 HCG levels.

AB - Objective To validate whether change in serum HCG levels between days 0 and 4 confer any prognostic value during methotrexate therapy and to quantify its change. Study design This is a retrospective study of 48 tubal ectopic pregnancies treated with single dose methotrexate protocol at University Hospital, Muscat, Oman from January 2012 to December 2013. The clinical outcome was analyzed based on the complete resolution of HCG levels or need for additional doses of methotrexate or recourse to surgery. The percentage change in HCG levels between days 0 and 4 (HCG index) of methotrexate were calculated and receiver operator characteristics curve was plotted to identify the best cutoff levels. In order to get a robust 95% confidence interval, bootstrap method using R software was done using 1000 re-sampling. ROC curve and the predictive values were estimated using MEDCALC software. Results The mean HCG level on day 4 is significantly higher in treatment failure group (4254 ± 4095 IU/L vs. 2109 ± 3646 IU/L, P = 0.008). The HCG levels between day 0 and 4 decreased in 42.7% (21/48) of cases and 80.9% of these cases had treatment success. The HCG levels increased in 57.4% (27/48) of cases and 33.3% of these cases had treatment success. (P = 0.001). A 10 percent decline in day 4 HCG levels predict the treatment success with sensitivity of 77% and Specificity 81%. The area under the ROC curve was 0.82 (95% CI: 0.67–0.92), (P < 0.001). Conclusion The success with single dose of methotrexate therapy for tubal ectopic pregnancies was predicted early in the course of treatment by following three key findings: the absolute mean HCG values on day 4, decrease in HCG level from day 0 to 4 and 10% or more fall in day 4 HCG levels.

KW - Ectopic pregnancy

KW - HCG

KW - Medical management

KW - Methotrexate

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