Declined eGFR Associated With Poor Prognosis in COVID-19 Patients in Wuhan, China: A Retrospective Cohort Study (preprint)

Background: Increasing evidence revealed that kidney was one of the targets of SARS-CoV-2. However, the incidences of kidney abnormalities were significantly different, from 0·5 to 75·4% in coronavirus disease 2019 (COVID-19) patients. The association of kidney injury with prognosis remain controversial.Methods: In this retrospective cohort study, laboratory confirmed COVID-19 in patients with severe type were enrolled. Demographic, clinical, and laboratory data were collected. Association of estimated glomerular filtration rate (eGFR) with 28-days mortality was analyzed.Findings: The total 28-days mortality of hospitalization was 22·3% (79/354). Non-survivors had a significantly declined eGFR levels than survivors (75·95 [IQR: 47·22,92·84] ml/min/1·73m2 vs. 96·43 [IQR: 84·11,108·47] ml/min/1·73m2, P <0·0001). The 28-days mortality in declined eGFR group (<90 ml/min/1·73m2) was significantly higher than that in normal eGFR group (38·5% vs. 10·7%, P <0·0001). Multivariate logistic regression revealed that the independent risk factors of 28-days outcome included lower eGFR (OR: 3·97, 95%CI: 1·42-11·11), elevated WBC (OR: 7·08, 95%CI: 3·15-15·90), lymphopenia (OR: 2·58, 95%CI: 1·21-5·49), and IL-6 (OR: 7·90, 95%CI: 2·19-28·49). Kaplan-Meier analysis indicated the survival disadvantage in patients with declined eGFR. ROC curve showed the eGFR cut-off value for predicting 28-days death was 82·2 μmol/L, with the sensitivity of 76·7%, and specialty of 66·3%.Interpretation: Declined eGFR was associated with poor prognosis, and could be used an independent risk factor of 28-days mortality in COVID-19 patients. Early detection, and surveillance for eGFR may benefit to identify patients with high-risk of progression.Funding Information: Program of Key Talents of Medical Science in Jiangsu Province, Suzhou science and technology development plan.Declaration of Interests: The authors have declared that no conflict of interest exists.Ethics Approval Statement: This study was approved by the institutional review boards at the First Affiliated Hospital of Soochow University and Wuhan Tongji Hospital. As COVID-19 is an emerging infectious disease, the written informed consent was exempted.

Declined eGFR Associated with Poor Prognosis in COVID-19 Patients in Wuhan, China: A Retrospective Cohort Study (preprint)

Background: Increasing evidence revealed that kidney was one of the targets of SARS-CoV-2. However, the incidences of kidney abnormalities were significantly different, from 0.5 to 75.4% in coronavirus disease 2019 (COVID-19) patients. The association of kidney injury with prognosis remain controversial. Methods: : In this retrospective cohort study, laboratory confirmedCOVID-19inpatients with severe type were enrolled. Demographic, clinicaland laboratory data were collected. Association of estimated glomerular fifiltration rate (eGFR)with 28-days mortality was analyzed. Results: : The total 28-days mortality of hospitalizationwas 22.3% (79/354). Non-survivors had a significantly declined eGFR levels than survivors (75.95 [IQR: 47.22,92.84] ml/min/1.73m 2 vs. 96.43 [IQR: 84.11,108.47] ml/min/1.73m 2 , P <0.001). The 28-days mortality in declined eGFR group (<90 ml/min/1.73m 2 ) was significantly higher than that in normal eGFR group (38.5% vs. 10.7%, P <0.001). Multivariate logistic regression revealed that the independent risk factors of 28-days outcome included lower eGFR (OR: 3.97, 95%CI: 1.42-11.11), elevated WBC (OR: 7.08, 95%CI: 3.15-15.90), lymphopenia (OR: 2.58, 95%CI: 1.21-5.49)andIL-6 (OR: 7.90, 95%CI: 2.19-28.49). Kaplan-Meier analysis indicated the survival disadvantage in patients with declined eGFR. ROC curve showed the eGFR cut-off value for predicting 28-days death was 82.2 μmol/L, with the sensitivity of 76.7% and speciality of 66.3%. Conclusion: Declined eGFR was associated with poor prognosis and could be used an independent risk factor of 28-days mortality in COVID-19 patients. Early detection and surveillance for eGFR may benefit to identify patients with high-risk ofprogression.

Clinical Features and Lymphocyte Subsets in Recovered Covid-19 Patients With Prolonged Viral Rna Shedding Duration (preprint)

Background:The 2019 novel coronavirus disease (COVID-19) spread in many countries.Data about viral shedding duration, particularly the prolonged ones of the pathogen SARS-Coronavirus-2 (SARS-CoV-2) is scarce. The longest viral RNA sheddingduration reported previously was 37 days. Herein, we report the clinical and immunologic features ofrecovered COVID-19cases with a medium viral RNA shedding duration of 44 days. Cases presentation: Nine laboratory-confirmed COVID-19 cases from Wuhan with viral RNA shedding duration more than 30 days were included in our study,5 of them were moderate.Althoughinflammatory markers were significantlyhigher, the medium duration in severepatients was similar to that in moderate patients (44.5days vs. 43.6days). Severepatients showed higher NK cells levels, although the T cells and B cells were lower as compared with moderate patients. Contrary to previous reports in influenza, prolonged viralshedding time did not cause poor prognosis in this study.Conclusions: There could be characteristic immunological dysfunction in COVID-19 patients with prolonged viral shedding durationand interestingly, prolonged viral shedding duration seemed not to be related with poor prognosis.