Validation of a Prospective Urinalysis-Based Prediction Model for ICU Resources and Outcome of COVID-19 Disease: A Multicenter Cohort Study

Abstract

In COVID-19, guidelines recommend a urinalysis on hospital admission as SARS-CoV-2 renal tropism, post-mortem, was associated with disease severity and mortality. Following the hypothesis from our pilot study, we now validate an algorithm harnessing urinalysis to predict the outcome and the need for ICU resources on admission to hospital. Patients were screened for urinalysis, serum albumin (SA) and antithrombin III activity (AT-III) obtained prospectively on admission. The risk for an unfavorable course was categorized as (1) “low”, (2) “intermediate” or (3) “high”, depending on (1) normal urinalysis, (2) abnormal urinalysis with SA ≥ 2 g/dL and AT-III ≥ 70%, or (3) abnormal urinalysis with SA or AT-III abnormality. Time to ICU admission or death served as the primary endpoint. Among 223 screened patients, 145 were eligible for enrollment, 43 falling into the low, 84 intermediate, and 18 into high-risk categories. An abnormal urinalysis significantly elevated the risk for ICU admission or death (63.7% vs. 27.9%; HR 2.6; 95%-CI 1.4 to 4.9; p = 0.0020) and was 100% in the high-risk group. Having an abnormal urinalysis was associated with mortality, a need for mechanical ventilation, extra-corporeal membrane oxygenation or renal replacement therapy. In conclusion, our data confirm that COVID-19-associated urine abnormalities on admission predict disease aggravation and the need for ICU (ClinicalTrials.gov number NCT04347824).

Urinalysis, but Not Blood Biochemistry, Detects the Early Renal Impairment in Patients with COVID-19

“…These findings show that renal impairment is widespread in both severe and non-severe COVID-19 individuals and that urine routine tests are more sensitive than blood biochemistry markers such as high Scr and BUN. These results intersect with those of O Gross et al ( 2021), who also recognized the relevance of urinalysis and designated it as the first inspector in a proposed COVID-19 risk assessment algorithm [32].…”

How Is Mass Spectrometry Tackling the COVID-19 Pandemic?

“…These profiles can be the basis for developing clinical testing for COVID-19 severity prognosis, which relies on targeted strategies using reliable and low-cost effective (accessible) instrumentation. Examples of such diagnostic methods that can be used to determine the severity of COVID-19 patients are image-based diagnostics looking for lung inflammation (Docherty et al, 2020;Guan et al, 2020;Liu et al, 2020;Okolo et al, 2021) and blood/urine-based approaches looking for inflammation, cardiovascular, diabetes-type, and liver dysfunction biomarkers (Gross et al, 2020;Gross et al, 2021;Siemens Healthineers. Lev, 2021).…”

Update zu: COVID-19 und die Niere – Klinik

“…Unsere Hypothese aus April 2020 [ 3 ] und Post-mortem-Daten [ 4 , 5 ] sowie der Göttinger Handlungspfad zur Früherkennung von Multiorganbeteiligung und drohenden Komplikationen mittels Urinstatus, Serumalbumin und Antithrombin-III-Aktivität konnten mittlerweile im Verbund mehrerer Universitätskliniken (Hamburg, Aachen, Köln-Merheim und Göttingen) in einer Prädiktionskohortenstudie validiert werden. Die (pathologische) Urinanalyse bei Krankenhausaufnahme als Hinweis auf Nierenschaden und/oder Nierenbeteiligung durch COVID-19 ermöglicht prospektiv die Identifikation von Patienten mit erhöhtem Risiko für einen schweren Krankheitsverlauf (Aufnahme auf eine Intensivstation oder Tod) und ist assoziiert mit der Notwendigkeit der invasiven Beatmung, ECMO(extrakorporale Membranoxygenierung)-Therapie, Dialysepflicht und Länge des Intensivaufenthalts [ 6 ].…”

“…Die Genese der Hypoalbuminämie bei Sepsis wird als sekundär durch erhöhte Permeabilität der Kapillaren („capillary leak“), verminderte Proteinsynthese und erniedrigte Halbwertszeit vermutet. Somit stellen nach heutigem Kenntnisstand sowohl der renale Tropismus wie auch die virale Sepsis durch SARS-CoV‑2 wichtige Risikofaktoren für eine COVID-19-assoziierte Nierenschädigung dar [ 3 – 6 , 11 ].…”