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 language | English |
|---|---|
| Pages (from-to) | 230-233 |
| Number of pages | 4 |
| Journal | European Journal of Obstetrics Gynecology and Reproductive Biology |
| Volume | 215 |
| DOIs | |
| Publication status | Published - Aug 1 2017 |
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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 journal › Article
}
TY - JOUR
T1 - Role of day 4 HCG as an early predictor of success after methotrexate therapy for ectopic pregnancies
AU - Girija, S.
AU - Manjunath, A. P.
AU - Salahudin, A.
AU - Jeyaseelan, L.
AU - Gowri, V.
AU - Abu-Heija, A.
AU - Al Kharusi, L.
PY - 2017/8/1
Y1 - 2017/8/1
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
UR - http://www.scopus.com/inward/record.url?scp=85021626484&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85021626484&partnerID=8YFLogxK
U2 - 10.1016/j.ejogrb.2017.06.020
DO - 10.1016/j.ejogrb.2017.06.020
M3 - Article
C2 - 28683376
AN - SCOPUS:85021626484
VL - 215
SP - 230
EP - 233
JO - European Journal of Obstetrics and Gynecology and Reproductive Biology
JF - European Journal of Obstetrics and Gynecology and Reproductive Biology
SN - 0028-2243
ER -