Background : Proteomic analysis of amniotic fluid shows the presence of biomarkers characteristic of\nintrauterine inflammation. We sought to validate prospectively the clinical utility of one such\nproteomic profile, the Mass Restricted (MR) score.\nMethods and Findings: We enrolled 169 consecutive women with singleton pregnancies admitted with preterm\nlabor or preterm premature rupture of membranes. All women had a clinically indicated\namniocentesis to rule out intra-amniotic infection. A proteomic fingerprint (MR score) was\ngenerated from fresh samples of amniotic fluid using surface-enhanced laser desorption\nionization (SELDI) mass spectrometry. Presence or absence of the biomarkers of the MR score\nwas interpreted in relationship to the amniocentesis-to-delivery interval, placental inflammation,\nand early-onset neonatal sepsis for all neonates admitted to the Newborn Special Care\nUnit (n Ã?¼ 104). Women with ââ?¬Ë?ââ?¬Ë?severeââ?¬â?¢Ã¢â?¬â?¢ amniotic fluid inflammation (MR score of 3 or 4) had\nshorter amniocentesis-to-delivery intervals than women with ââ?¬Ë?ââ?¬Ë?noââ?¬â?¢Ã¢â?¬â?¢ (MR score of 0)\ninflammation or even ââ?¬Ë?ââ?¬Ë?minimalââ?¬â?¢Ã¢â?¬â?¢ (MR score of 1 or 2) inflammation (median [range] MR 3ââ?¬â??4:\n0.4 d [0.0ââ?¬â??49.6 d] versus MR 1ââ?¬â??2: 3.8 d [0.0ââ?¬â??151.2 d] versus MR 0: 17.0 d [0.1ââ?¬â??94.3 d], p , 0.001).\nNonetheless, a ââ?¬Ë?ââ?¬Ë?minimalââ?¬â?¢Ã¢â?¬â?¢ degree of inflammation was also associated with preterm birth\nregardless of membrane status. There was a significant association between the MR score and\nseverity of histological chorioamnionitis (r Ã?¼ 0.599, p , 0.001). Furthermore, neonatal\nhematological indices and early-onset sepsis significantly correlated with the MR score even\nafter adjusting for gestational age at birth (OR for MR 3ââ?¬â??4: 3.3 [95% CI, 1.1 to 9.2], p Ã?¼ 0.03).\nWhen compared with other laboratory tests routinely used to diagnose amniotic fluid\ninflammation and infection, the MR score had the highest accuracy to detect inflammation\n(white blood cell count . 100 cells/mm3), whereas the combination of Gram stain and MR\nscore was best for rapid prediction of intra-amniotic infection (positive amniotic fluid culture).\nConclusions: High MR scores are associated with preterm delivery, histological chorioamnionitis, and earlyonset\nneonatal sepsis. In this study, proteomic analysis of amniotic fluid was shown to be the\nmost accurate test for diagnosis of intra-amniotic inflammation, whereas addition of the MR\nscore to the Gram stain provides the best combination of tests to rapidly predict infection.
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