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Prognostic Significance of Urinary Biomarkers in Patients Hospitalized With COVID-19.
Menez, Steven; Moledina, Dennis G; Thiessen-Philbrook, Heather; Wilson, F Perry; Obeid, Wassim; Simonov, Michael; Yamamoto, Yu; Corona-Villalobos, Celia P; Chang, Crystal; Garibaldi, Brian T; Clarke, William; Farhadian, Shelli; Dela Cruz, Charles; Coca, Steven G; Parikh, Chirag R.
  • Menez S; Division of Nephrology, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
  • Moledina DG; Section of Nephrology and Clinical and Translational Research Accelerator, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.
  • Thiessen-Philbrook H; Division of Nephrology, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
  • Wilson FP; Section of Nephrology and Clinical and Translational Research Accelerator, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.
  • Obeid W; Division of Nephrology, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
  • Simonov M; Section of Nephrology and Clinical and Translational Research Accelerator, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.
  • Yamamoto Y; Section of Nephrology and Clinical and Translational Research Accelerator, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.
  • Corona-Villalobos CP; Division of Nephrology, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
  • Chang C; Division of Nephrology, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
  • Garibaldi BT; Division of Pulmonary and Critical Care, Department of Medicine, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, 3Division of Medical Microbiology, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
  • Clarke W; Division of Clinical Chemistry, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
  • Farhadian S; Section of Infectious Disease, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.
  • Dela Cruz C; Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.
  • Coca SG; Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
  • Parikh CR; Division of Nephrology, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland. Electronic address: chirag.parikh@jhmi.edu.
Am J Kidney Dis ; 79(2): 257-267.e1, 2022 02.
Article in English | MEDLINE | ID: covidwho-1575031
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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Acute Kidney Injury / COVID-19 Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study Limits: Humans Language: English Journal: Am J Kidney Dis Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Acute Kidney Injury / COVID-19 Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study Limits: Humans Language: English Journal: Am J Kidney Dis Year: 2022 Document Type: Article