Highlights Coronovirus 2019 (COVID-19) infection induces cytokine storm causing mortality. Interleukin (IL)-18 is one of the key cytokines in the macrophage activation syndrome. IL-18 elevated in COVID-19 patients and might be a therapeutic target.

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The COVID-19-related death rate varies between countries and is affected by various risk factors. This multicenter registry study was designed to evaluate the mortality rate and the related risk factors in Turkey. We retrospectively evaluated 1500 adults with COVID-19 from 26 centers who were hospitalized between March 11 and July 31, 2020. In the study group, 1041 and 459 cases were diagnosed as definite and highly probable cases, respectively. There were 993 PCR-positive cases (66.2%). Among all cases, 1144 (76.3%) were diagnosed with non-severe pneumonia, whereas 212 (14.1%) had severe pneumonia. Death occurred in 67 patients, corresponding to a mortality rate of 4.5% (95% CI:3.5-5.6). The univariate analysis demonstrated that various factors, including male sex, age ≥65 years and the presence of dyspnea or confusion, malignity, chronic obstructive lung disease, interstitial lung disease, immunosuppressive conditions, severe pneumonia, multiorgan dysfunction, and sepsis, were positively associated with mortality. Favipiravir, hydroxychloroquine and azithromycin were not associated with survival. Following multivariate analysis, male sex, severe pneumonia, multiorgan dysfunction, malignancy, sepsis and interstitial lung diseases were found to be independent risk factors for mortality. Among the biomarkers, procalcitonin levels on the 3 rd -5 th days of admission showed the strongest associations with mortality (OR: 6.18; 1.6-23.93). This study demonstrated that the mortality rate in hospitalized patients in the early phase of the COVID-19 pandemic was a serious threat and that those patients with male sex, severe pneumonia, multiorgan dysfunction, malignancy, sepsis and interstitial lung diseases were at increased risk of mortality; therefore, such patients should be closely monitored.

Aim This study aims to determine the frequency of COVID‐19 related AKI and to identify the early predictors of AKI. Methods This study is a single‐center, retrospective, observational study. Hospitalized COVID‐19 patients between 24/03/2020 and 31/05/2020 were included in the study. All patients were evaluated for renal dysfunctions with urine dipstick, protein/creatinine ratio, albumin/creatinine ratio in spot urine, serum cystatin C, serum creatinine level on hospital admission, and 28th day of hospital admission. To assess the utility of these parameters to predict AKI, a receiver‐operating characteristic curve was generated and the area under the curve (AUC) was calculated. Results 348 patients were included. The average incidence of AKI was 4.9% (n = 17). The incidence of AKI in mild, moderate and severe COVID‐19 cases was 1.3% (n = 4), 9.0% (n = 3) and 76.9% (n = 10), respectively. Proteinuria was detected in 7.8% (n = 27) of patients with a urine dipstick test. In spot urine analysis, proteinuria was found in 20.1% (n = 70) of patients. The frequency of persistent proteinuria was 5.2% (n = 18). The AUC alue of serum cystatin C, D‐dimer and albumin/creatinine ratio to predict COVID‐19 related AKI were 0.96 (0.90 to 1.0), 0.94 (0.89–0.98), and 0.95 (0.91–0.98). Conclusion In COVID‐19 patients with normal serum creatinine levels on hospital admission, albuminuria, serum cystatin C and D‐dimer levels may be an early predictor of COVID‐19 related AKI and these patients should be monitored closely for AKI. Since the sample size in the AKI group was small, our study results should be confirmed with larger cohort studies.

In Coronavirus disease‐2019 (COVID‐19) cases, hyper inflammation is associated with the severity of the disease. High levels of circulating cytokines were reported in severe COVID‐19 patients. Neopterin produced by macrophages on stimulation with interferon‐gamma, which is an important cytokine in the antiviral immune response, hence it can be used to predict the severity of disease in COVID‐19 cases. In this study, it was aimed to determine the prognostic value of the neopterin for the prediction of severe disease in patients with COVID‐19. This single‐center, prospective study was conducted in hospitalized COVID‐19 patients and healthy volunteers. Severe and mild COVID‐19 cases were compared in terms of clinical and laboratory findings as well as serum neopterin levels on hospital admission. To assess the prognostic utility of neopterin between the severe and mild COVID‐19 groups, a receiver‐operating characteristic (ROC) curve was generated, and the area under the curve (AUC) was calculated. The median serum neopterin level was four times higher in COVID‐19 patients than the healthy controls (46 vs. 12 nmol/L; p < .001). The AUC value of serum neopterin was 0.914 (95% confidence interval, 0.85–0.97). The sensitivity and specificity of serum neopterin for the cut‐off value of 90 nmol/L to identify severe COVID‐19 cases were 100% and 76%, respectively. Serum neopterin levels on hospitalization were significantly higher in severe COVID‐19 disease than mild COVID‐19 patients. Neopterin levels can be used as an early prognostic biomarker for COVID‐19 on admission.