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

Abstract

RATIONALE & OBJECTIVE:

Acute kidney injury (AKI) is common in patients with coronavirus disease 2019 (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 and adverse kidney outcomes among patients hospitalized with COVID-19.

STUDY DESIGN:

Prospective cohort study.

SETTING & PARTICIPANTS:

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

EXPOSURE:

19 urinary biomarkers of injury, inflammation, and repair.

OUTCOME:

Composite of KDIGO (Kidney Disease: Improving Global Outcomes) 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.

ANALYTICAL 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. Twofold 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.

CONCLUSIONS:

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.

• Authors: Steven Menez, Dennis G Moledina, Heather Thiessen-Philbrook, F Perry Wilson, Wassim Obeid, Michael Simonov, Yu Yamamoto, Celia P Corona-Villalobos, Crystal Chang, Brian T Garibaldi, William Clarke, Shelli Farhadian, Charles Dela Cruz, Steven G Coca, Chirag R Parikh, TRIKIC Consortium Investigators
• Journal: American journal of kidney diseases : the official journal of the National Kidney Foundation (Am J Kidney Dis) Vol. 79 Issue 2 Pg. 257-267.e1 (02 2022) ISSN: 1523-6838 [Electronic] United States
• PMID: 34710516 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Chemical References

• Biomarkers
• Lipocalin-2
• Creatinine

Topics

• Acute Kidney Injury (diagnosis, epidemiology)
• Biomarkers
• COVID-19
• Creatinine
• Humans
• Lipocalin-2
• Prognosis
• Prospective Studies
• SARS-CoV-2