Urine biomarkers for the prediction of mortality in COVID-19 hospitalized patients

Morell-García, Daniel; Ramos-Chavarino, David; Bauça, Josep Miquel; Castillo, P. Argente Del; Ballesteros-Vizoso, Maria Antonieta; Guadiana-Romualdo, Luis García de; Gómez-Cobo, Cristina; Pou, Joan Albert; Amezaga-Menéndez, Rocío; Alonso-Fernández, Alberto; Llompart, Isabel; García-Raja, A.

doi:10.1038/s41598-021-90610-y

Cited by 24 publications

(26 citation statements)

References 38 publications

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“…The predictive model was included and it was shown that LDH can be a useful tool in the management of patients requiring hospitalisation for a SARS‐CoV‐2 infection. 14 In our study, age (OR: 1.06, 95% CI 1.03‐1.10, P = .035), respiratory rate ≥ 30 breaths/min (OR: 4.72, 95% CI 1.26‐6.24, P < .0031), SpO 2 ≤ 93% (OR: 3.82, 95% CI 1.18‐5.82, P = .001) and proteinuria (OR: 1.13, 95% CI 1.02‐2.1, P = .023) were independent predictive factors for disease severity.…”

Section: Discussionmentioning

confidence: 99%

Is there an association between urine biochemical parameters on admission and the severity OF COVID‐19?

Erdoğan

Carkci

et al. 2021

Int J Clin Pract

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In late 2019, a pneumonia epidemic began in Wuhan, China's Hubei Province, with a primarily unknown cause, which is now known to have spread significantly worldwide. 1 The virus that caused the disease was initially named the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and later the World Health Organization described this disease as coronavirus disease-2019 This disease usually affects individuals between the ages of 30 and 79 years. About half of those with COVID-19 have mild or indeterminate symptoms. Significant symptoms in symptomatic patients include fatigue, fever, cough, muscle pain and shortness of breath. 2,3 Sometimes, more critical conditions, such as acute respiratory distress syndrome (ARDS) and multi-organ failure can be observed.Patients with these severe conditions often have comorbid diseases, especially hypertension (HT), diabetes mellitus (DM) and heart diseases. 3 Neutrophilia and lymphopenia are the most common laboratory parameters. Abnormal liver function test findings at different rates have also been reported. Serum procalcitonin levels are generally at normal levels, while mild increases in C-reactive protein levels can be seen. Moreover, D-dimer levels are high in 30% of patients. 4,5 Coronaviruses are enveloped RNA viruses that consist of a single chain and have a positive polarity. Therefore, they do not have RNA-dependent RNA polymerase enzymes, but this enzyme code

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Section: Discussionmentioning

confidence: 99%

Is there an association between urine biochemical parameters on admission and the severity OF COVID‐19?

Erdoğan

Carkci

et al. 2021

Int J Clin Pract

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“…Despite tubular injury being the predominant pathologic lesion, proteinuria and hematuria appear to be relatively prominent in COVID-19-associated AKI [7,15,17,24,31,32]. Specifically, >40% of patients hospitalized for COVID-19 have proteinuria when assessed by qualitative urinalysis [7,15,32,81,82]. Similarly high rates of proteinuria were observed in two studies in which patients admitted with COVID-19 underwent quantitative proteinuria assessment, with 19 (83%) of 23 patients (of which 12 developed AKI) having proteinuria >150 mg per g creatinine in one study and 33 (63.5%) of 52 patients (of which 34 developed AKI) having albuminuria of >30 mg per g creatinine in the other [24,83].…”

Section: Hemoproteinuria In Covid-19-associated Akimentioning

confidence: 99%

Kidney Injury in COVID-19: Epidemiology, Molecular Mechanisms and Potential Therapeutic Targets

Teixeira

Barone

Zahedi

et al. 2022

IJMS

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As of December 2021, SARS-CoV-2 had caused over 250 million infections and 5 million deaths worldwide. Furthermore, despite the development of highly effective vaccines, novel variants of SARS-CoV-2 continue to sustain the pandemic, and the search for effective therapies for COVID-19 remains as urgent as ever. Though the primary manifestation of COVID-19 is pneumonia, the disease can affect multiple organs, including the kidneys, with acute kidney injury (AKI) being among the most common extrapulmonary manifestations of severe COVID-19. In this article, we start by reflecting on the epidemiology of kidney disease in COVID-19, which overwhelmingly demonstrates that AKI is common in COVID-19 and is strongly associated with poor outcomes. We also present emerging data showing that COVID-19 may result in long-term renal impairment and delve into the ongoing debate about whether AKI in COVID-19 is mediated by direct viral injury. Next, we focus on the molecular pathogenesis of SARS-CoV-2 infection by both reviewing previously published data and presenting some novel data on the mechanisms of cellular viral entry. Finally, we relate these molecular mechanisms to a series of therapies currently under investigation and propose additional novel therapeutic targets for COVID-19.

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“…Although several studies reported proteinuria and hematuria in conjunction with COVID-19 infection [ 7 – 16 ], only a few evaluated differences in the incidence of proteinuria and hematuria on dipstick urinalysis in patients with AKI as compared to those without AKI [ 9 – 11 , 13 , 17 ]. Even fewer studies investigated the association between proteinuria and hematuria with development of AKI and need for RRT [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…One study reported that a urine protein-to-creatinine ratio (UPCR) ≥ 1 g/g on admission was associated with an increased risk of requiring RRT; albeit, these results may not be readily generalizable as UPCR is not one of the commonly obtained laboratory tests at admission [ 18 ]. Most of the other studies had small sample sizes, ranging from 129–307 total participants [ 8 , 16 , 19 , 20 ], and two did not have a non-AKI control group [ 12 , 21 ]. A larger, recently published study reported that presence of proteinuria and hematuria ≥ 1 + was associated with an increased risk of AKI [ 17 ] but did not exclude AKI present on admission, limiting the ability to predict development of AKI during hospitalization with COVID-19.…”

Section: Introductionmentioning

confidence: 99%

Using dipstick urinalysis to predict development of acute kidney injury in patients with COVID-19

McAdams

et al. 2022

BMC Nephrol

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Background Acute kidney injury (AKI) is a common complication in patients hospitalized with COVID-19 and may require renal replacement therapy (RRT). Dipstick urinalysis is frequently obtained, but data regarding the prognostic value of hematuria and proteinuria for kidney outcomes is scarce. Methods Patients with positive severe acute respiratory syndrome-coronavirus 2 (SARS-CoV2) PCR, who had a urinalysis obtained on admission to one of 20 hospitals, were included. Nested models with degree of hematuria and proteinuria were used to predict AKI and RRT during admission. Presence of Chronic Kidney Disease (CKD) and baseline serum creatinine were added to test improvement in model fit. Results Of 5,980 individuals, 829 (13.9%) developed an AKI during admission, and 149 (18.0%) of those with AKI received RRT. Proteinuria and hematuria degrees significantly increased with AKI severity (P < 0.001 for both). Any degree of proteinuria and hematuria was associated with an increased risk of AKI and RRT. In predictive models for AKI, presence of CKD improved the area under the curve (AUC) (95% confidence interval) to 0.73 (0.71, 0.75), P < 0.001, and adding baseline creatinine improved the AUC to 0.85 (0.83, 0.86), P < 0.001, when compared to the base model AUC using only proteinuria and hematuria, AUC = 0.64 (0.62, 0.67). In RRT models, CKD status improved the AUC to 0.78 (0.75, 0.82), P < 0.001, and baseline creatinine improved the AUC to 0.84 (0.80, 0.88), P < 0.001, compared to the base model, AUC = 0.72 (0.68, 0.76). There was no significant improvement in model discrimination when both CKD and baseline serum creatinine were included. Conclusions Proteinuria and hematuria values on dipstick urinalysis can be utilized to predict AKI and RRT in hospitalized patients with COVID-19. We derived formulas using these two readily available values to help prognosticate kidney outcomes in these patients. Furthermore, the incorporation of CKD or baseline creatinine increases the accuracy of these formulas.

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Urine biomarkers for the prediction of mortality in COVID-19 hospitalized patients

Cited by 24 publications

References 38 publications

Is there an association between urine biochemical parameters on admission and the severity OF COVID‐19?

Is there an association between urine biochemical parameters on admission and the severity OF COVID‐19?

Kidney Injury in COVID-19: Epidemiology, Molecular Mechanisms and Potential Therapeutic Targets

Using dipstick urinalysis to predict development of acute kidney injury in patients with COVID-19

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