Serum activin A does not predict ectopic pregnancy as a single measurement test, alone or as part of a multi-marker panel including progesterone and hCG

BackgroundTo evaluate the diagnostic accuracy of activin A alone or in a multi-marker panel for the prediction of ectopic pregnancy (EP).MethodsA retrospective analysis was performed on a cohort of 289 women who presented to the emergency department (ED) with vaginal bleeding and/or abdominal pain/cramping and were diagnosed with EP, spontaneous abortion, or viable intrauterine pregnancy. Serum progesterone, hCG, and activin A concentrations were measured on the samples obtained in the ED. Statistical analysis was performed to determine the clinical utility of these biomarkers as single measurement and as a multi-marker panel test for ectopic pregnancy. Women ≥ 18 y with vaginal bleeding or abdominal pain/cramping.ResultsProgesterone (< 10 ng/ml), hCG (< 6,699 IU/l), and activin A (< 0.26 ng/ml) cutoffs were optimized by ROC analysis. These demonstrated sensitivities of 62.9%, 74.2%, and 59.6%, and specificities of 60.5%, and 63.0%, and 61.0% respectively for detecting EP. The multi-marker panel utilizing all three biomarkers had a sensitivity of 70% and specificity of 69%.ConclusionSerum activin A cannot be used as a single measurement or in a multi-marker panel with progesterone and hCG to predict EP.

► A serum marker for ectopic pregnancy would be clinically useful. ► Previous studies of Activin A in ectopic pregnancy have been contradictory. ► We test the utility of serum Activin A in diagnosing ectopic pregnancy. ► We find Activin A is a poor marker of ectopic pregnancy.