Plasma urocortin-1 as a preoperative marker of endometriosis in symptomatic women

Abstract

Accurate noninvasive diagnostic tests for endometriosis are still missing. This study evaluated the predictive value of the neuropeptide urocortin 1 (Ucn1) to detect pelvic endometriosis in symptomatic women. We enrolled prospectively 97 consecutive women submitted to gynecologic laparoscopy for chronic or acute pelvic pain, infertility or adnexal mass. Preoperative blood samples were assayed for Ucn1 using enzyme immunoassay. Patients with endometriosis had higher plasma Ucn1 levels compared to patients with no lesions (median 59 vs. 34 pg/ml, p < .01, Dunn's test). Elevated plasma Ucn1 levels were found among all endometriosis phenotypes (superficial peritoneal lesions, ovarian endometrioma, and deep infiltrating endometriosis, p < .05 vs. no lesions). Receiver operating characteristics curve analysis identified plasma Ucn1 > 46 pg/mL as the best cutoff point to detect endometriosis vs. no lesions, with 76% sensitivity and 88% specificity (area under the curve [AUC] 0.827, 95% confidence interval [CI] 0.695 − 0.959), but no cutoff could accurately distinguish endometriosis from other pathological conditions (AUC 0.593 [95% CI 0.474 − 0.711]). In women with chronic pelvic pain, infertility, or both symptoms, the probability of endometriosis (positive predictive value) increased consistently with the increase of plasma Ucn1 levels. The present findings suggest that high plasma Ucn1 levels increase the likelihood of endometriosis in symptomatic women.

Chinese abstract

目前仍没有精确无误的子宫内膜异位症诊断性检测。本研究评估了神经肽尿皮质素-1检测有症状妇女盆腔子宫内膜异位症的预测价值。我们预期连续招募97名女性接受妇科腹腔镜手术, 以治疗慢性或急性盆腔疼痛、不孕或附件肿块, 采用酶免疫测定法检测术前血样中的尿皮质素-1（Ucn1）水平。子宫内膜异位症患者的血浆Ucn1水平高于无病变患者（中位数59 VS.34 pg/ml, p <0.01, Dunn's test）。在所有的子宫内膜异位症表型中均发现血浆Ucn1水平升高（浅表腹膜病变, 卵巢子宫内膜异位和深部浸润性子宫内膜异位症VS.无病变, p < 0.05）。ROC曲线分析确定血浆Ucn1 > 46 pg/ml作为检测子宫内膜异位症与无病变的最佳分界点, 灵敏度为76%和特异度为88%（曲线下面积[AUC]:0.827, 95%置信区间[CI]:0.695—0.959）, 但没有能够准确区分子宫内膜异位症与其他病理情况的分界点（AUC: 0.593[95%CI: 0.474—0.711]）。在慢性盆腔疼痛、不孕症或两种症状都有的女性中, 子宫内膜异位症的可能性（阳性预测值）随着血浆Ucn1水平的增加而一致增加。目前的研究结果表明高血浆Ucn1水平增加有症状妇女子宫内膜异位症的可能性。

Keywords:

• urocortin-1
• endometriosis
• biomarker
• pain
• infertility

Disclosure statement

The authors report no conflict of interest.

Additional information

Funding

Research supported by FAPEMIG and CNPq through the Brazilian National Institute of Hormones and Women’s Health.