The Value of Serum Β-Subunit of Human Chorionic Gonadotropin Level in Prediction of Treatment Response to Methotrexate in Management of Ectopic Pregnancy; a Systematic Review and Meta-Analysis

Authors

1 Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran.

2 Physiology Research Center and Department of Physiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.

3 Department of Nutrition and Biochemistry, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

4 Department of Emergency Medicine, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

5 Pediatric Chronic Kidney Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran and Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

6 Department of Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

7 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Abstract

Background: No consensus has been reached on prognostic value of serum concentration of β (beta) subunit of human chorionic gonadotropin (β-hCG) in treatment response to methotrexate in management of ectopic pregnancy. Therefore, the present study aimed to evaluate this subject through a systematic review and meta-analysis.
Materials and Methods: An extensive literature search on online databases was performed. All studies performed on ectopic pregnancy patients treated by methotrexate from all age groups were included. After collecting data, random effect models were used to calculate the pooled standardized mean difference (SMD) of β-hCG level in treatment success and treatment failure groups. Finally, pooled performance screening characteristics of serum β-hCG level were assessed in different cut offs.
Results: Finally, 51 articles were included in meta-analysis. Overall treatment success rate of methotrexate was 84% [95% confidence interval (CI): 84-85 percent]. A negative association was found between serum β-hCG level and the treatment response before intervention (SMD= -1.10, 95% CI: -1.39 to -0.88). In addition, pooled sensitivity, specificity, and prognostic odds ratio of β-hCG in the 2000 mIU/mL cut off were: 0.75 (0.65-0.82), 0.68 (0.58-0.82), and 6.0 (5.0-8.0), respectively.
Conclusion: The present meta-analysis showed that serum β-hCG concentration before treatment could predict success of methotrexate in management of ectopic pregnancy.

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