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Prognostic Significance of Urinary Biomarkers in Patients Hospitalized With COVID-19

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Title

Prognostic Significance of Urinary Biomarkers in Patients Hospitalized With COVID-19

Description

Acute kidney injury (AKI) is common in patients with COVID-19 and associated with poor outcomes. Urinary biomarkers have been associated with adverse kidney outcomes in other settings and may provide additional prognostic information in patients with COVID-19. We investigated the association between urinary biomarkers with adverse kidney outcomes among patients hospitalized with COVID-19.

Date

2021-10-16

Citation

Menez, S., D. G. Moledina, H. Thiessen-Philbrook, F. P. Wilson, W. Obeid, M. Simonov, Y. Yamamoto, C. P. Corona-Villalobos, C. Chang, B. T. Garibaldi, W. Clarke, S. Farhadian, C. Dela Cruz, S. G. Coca, and C. R. Parikh. 2021. "Prognostic Significance of Urinary Biomarkers in Patients Hospitalized With COVID-19." Am J Kidney Dis.

Abstract

Rationale and objective: Acute kidney injury (AKI) is common in patients with COVID-19 and associated with poor outcomes. Urinary biomarkers have been associated with adverse kidney outcomes in other settings and may provide additional prognostic information in patients with COVID-19. We investigated the association between urinary biomarkers with adverse kidney outcomes among patients hospitalized with COVID-19.

Study design: Prospective cohort study.

Setting and participants: Patients hospitalized with COVID-19 (n=153) at 2 academic medical centers between April and June 2020.

Exposures: 19 urinary biomarkers of injury, inflammation, and repair.

Outcomes: Composite of KDIGO stage 3 AKI, requirement for dialysis, or death within 60 days of hospital admission. We also compared various kidney biomarker levels in the setting of COVID-19 versus other common AKI settings.

Analytic approach: Time-varying Cox proportional hazards regression to associate biomarker level with composite outcome.

Results: Out of 153 patients, 24 (15.7%) experienced the primary outcome. Two-fold higher levels of neutrophil gelatinase-associated lipocalin (NGAL) (HR: 1.34; 95% CI: 1.14-1.57), monocyte chemoattractant protein (MCP-1) (HR: 1.42; 95% CI: 1.09-1.84), and kidney injury molecule-1 (KIM-1) (HR: 2.03; 95% CI: 1.38-2.99) were associated with highest risk of sustaining primary composite outcome. Higher epidermal growth factor (EGF) levels were associated with a lower risk of the primary outcome (HR 0.61; 95% CI: 0.47-0.79). Individual biomarkers provided moderate discrimination and biomarker combinations improved discrimination for the primary outcome. The degree of kidney injury by biomarker level in COVID-19 was comparable to other settings of clinical AKI. There was evidence of subclinical AKI in COVID-19 patients based on elevated injury biomarker level in patients without clinical AKI defined by serum creatinine.

Limitations: Small sample size with low number of composite outcome events.

Conclusion: Urinary biomarkers are associated with adverse kidney outcomes in patients hospitalized with COVID-19 and may provide valuable information to monitor kidney disease progression and recovery.

Keywords: COVID-19; acute kidney injury (AKI); biomarkers; chronic kidney disease (CKD).

Accessibility

Free online on journal website and PubMed Central.

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