Longitudinal urinary biomarkers of immunological activation in covid-19 patients without clinically apparent kidney disease versus acute and chronic failure

Abstract

Kidney function is affected in COVID-19, while kidney itself modulates the immune response. Here, hypothesize if COVID-19 urine biomarkers level can assess immune activation vs. clinical trajectory. Considering the kidney’s critical role in modulating the immune response, we sought to analyze activation markers in patients with pre-existing dysfunction. This was a cross-sectional study of 68 patients. Blood and urine were collected within 48 h of hospital admission (H1), followed by 96 h (H2), seven days (H3), and up to 25 days (H4) from admission. Serum level ferritin, procalcitonin, IL-6 assessed immune activation overall, while the response to viral burden was gauged with serum level of spike protein and αspike IgM and IgG. 39 markers correlated highly between urine and blood. Age and race, and to a lesser extend gender, differentiated several urine markers. The burden of pre-existing conditions correlated with urine DCN, CAIX and PTN, but inversely with IL-5 or MCP-4. Higher urinary IL-12 and lower CAIX, CCL23, IL-15, IL-18, MCP-1, MCP-3, MUC-16, PD-L1, TNFRS12A, and TNFRS21 signified non-survivors. APACHE correlated with urine TNFRS12, PGF, CAIX, DCN, CXCL6, and EGF. Admission urine LAG-3 and IL-2 predicted death. Pre-existing kidney disease had a unique pattern of urinary inflammatory markers. Acute kidney injury was associated, and to a certain degree, predicted by IFNg, TWEAK, MMP7, and MUC-16. Remdesavir had a more profound effect on the urine biomarkers than steroids. Urinary biomarkers correlated with clinical status, kidney function, markers of the immune system activation, and probability of demise in COVID-19.

The “ForensOMICS” approach to forensic post-mortem interval estimation: combining metabolomics, lipidomics and proteomics for the analysis of human bone

“…Creatinine has previously been reported to be a good marker in both muscle tissue 14 . Although it has not been mentioned in literature previously, we also found that neopterin, a biomarker for immune system activation commonly profiled in blood, serum, and urine 58,59 , has a strong negative correlation with PMI. Taurine, also in accordance with studies on vitreous humour 15 , showed a predictable positive behaviour with PMI.…”

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“…This research is exploratory in generating an idea that the immunological response to COVID-19 can be profiled. We found that some of our research overlapped with others [16,17,43,56,60]. Due to the abundance of caution, we did not conduct extensive correlational analysis, which is common in the works of others.…”

“…However, invasive techniques have to be used to obtain the sample. Consequently, increasing stress is placed on analyzing other sources of immunological information, including urine, sweat, stool, saliva, and others [35,43,44]. Urine can reflect the immunological performance in general as well.…”

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