Evaluation of Predictive Efficacy of β-hCG Levels at 0–4 Days for Single-dose Methotrexate Therapy in Ectopic Pregnancy

Abstract

Background: To assess the predictive efficacy of beta-human chorionic gonadotropin (β-hCG) value changes between 0–4 days for single-dose methotrexate (MTX) therapy for ectopic pregnancy (EP). Materials and Methods: Between September 2016 and August 2017, the treatment outcomes for patients who received MTX therapy for EP at the Health Sciences University GaziYaşargil Training and Research Hospital were evaluated retrospectively. The efficacy of the cut-off reduction values used in the study was determined through the receiver operator characteristic (ROC) volumetric analysis with ≥10% and >20% reductions in β-hCG values between 0–4 days. Results: Of the 132 patients who received single-dose MTX treatments, 78.8% (N = 104)had successful outcomes. A sensitivity of 65.3%, specificity of 71.4%, positive predictive value (PPV) of 89.4%, and negative predictive value (NPV) of 35.7% were found to be statistically significant when predictions of treatment success were based on reduced β-hCG values at 0–4 days (AUC:0.690, p<0.05). However, the β-hCG. reduction at 0–4 days >10%, >20% and the ROC was detected in the curve analysis, >10.4% were found AUC: 0.643 (p> 0.05), AUC: 0.614 (p> 0.05), AUC: 0.643 (p> 0.05) respectively. Conclusions: In this study, reduced β-hCG values were observed in cases of non-ruptured tubal EP after 0–4 days of single-dose MTX treatment; thus, the efficacy of the therapy was predictive and statistically significant. In addition, the β-hCG values at 0–4 days were reduced by >10%, >10.4% (cut-off value of current study), or >20% with a higher PPV for successful treatment outcomes although they were not statistically significant.