Abstract
BACKGROUND: Preeclampsia (PE), a grave obstetric complication, mandates the expeditious formulation of efficacious early diagnostic strategies. Accumulating evidence suggests that non - coding RNAs (ncRNAs), which are present in maternal circulation and placental tissues, display abnormal expression patterns in patients with PE, underscoring their potential as diagnostic biomarkers. This systematic review and meta - analysis intends to assess the diagnostic accuracy of ncRNAs for the detection of PE. METHODS: A comprehensive search was carried out across seven databases (China National Knowledge Infrastructure [CNKI], Wanfang Database, VIP Database, PubMed, Web of Science, Embase, and the Cochrane Library) up to December 25, 2024, to identify case - control and cohort studies exploring the diagnostic value of ncRNAs in PE. The quality of the studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies - 2 (QUADAS - 2) tool and the Newcastle - Ottawa Scale (NOS), and publication bias was assessed using Deeks' funnel plot. The pooled sensitivity (SEN), specificity (SPE), diagnostic odds ratio (DOR), and area under the curve (AUC) were computed using Review Manager 5.4 and Meta - DiSc 1.4. RESULTS: Among the 2,201 identified studies, 40 fulfilled the inclusion criteria for qualitative synthesis. Forty - eight ncRNAs showed diagnostic potential, including 25 microRNAs (miRNAs), 9 long non - coding RNAs (lncRNAs), and 6 circular RNAs (circRNAs). The pooled sensitivity and specificity were 80% (95% confidence interval [CI]: 76-84%) and 82% (95% CI: 79-85%), respectively. Single miRNA assays presented superior diagnostic performance (sensitivity [SEN]: 85%, specificity [SPE]: 85%) in comparison to circRNAs (SEN: 80%, SPE: 79%). Notably, combinatorial panels consisting of 2-3 ncRNAs attained optimal diagnostic performance, with a sensitivity of 91% (95% CI: 88-94%), a specificity of 80% (95% CI: 76-84%), and an area under the curve (AUC) of 0.9418 (standard error [SE] = 0.0152). CONCLUSION: Circulating ncRNAs exhibit significant potential as diagnostic biomarkers for PE, with multi-analyte panels providing improved diagnostic accuracy compared to single-marker strategies.