Can urine biomarkers predict severity of COVID-19? A preliminary study

ABSTRACT

Background: Early detection of coronavirus disease (COVID-19) in patients likely to develop severe manifestations enables appropriate interventions, including rapid intensive care unit admission. This study was conducted to determine whether noninvasive urine biomarkers can predict the clinical severity of COVID-19. Methods: Design A retrospective case series. Setting Single-center study, national center hospital designated for infectious disease. Patients Fifty-eight patients who tested positive for SARS-CoV-2 in respiratory specimens through real-time reverse transcription-polymerase chain reaction (RT-PCR) were retrospectively studied. Measurements and main results Urinary β2-microglobulin (β2MG), liver-type fatty acid-binding protein (L-FABP) were serially measured. Serum interferon γ and monocyte chemotactic protein-1 were also evaluated. Results: The 58 patients were assigned into three groups. Patients requiring intensive care were assigned to the severe group (N = 12). Patients treated with oxygen were assigned to the moderate group (N = 13). Other patients were assigned to the mild group (N = 33). Urine tests revealed that low β2MG and L-FABP levels on admission were associated with mild disease, whereas high levels were associated with severe disease. In severe cases, L-FABP tended to be persistently high. The resulting cutoff values were β2MG;Severe vs. Moderate+Mild 2457 μg/dL (Specificity 76.9% and Sensitivity 90.0%, AUC 85.9%), L-FABP;Severe vs. Moderate+Mild 22.0 μg/gCre (Specificity 84.6% and Sensitivity 90%, AUC 91.8%). Urinary β2MG and serum IFN-γ/MCP-1 showed a similar trend. Conclusions: Evaluating urinary biomarkers such as β2MG and L-FABP may allow determination of COVID-19 patients with active cytokines and recognition of patients likely to become critically ill and requiring careful observation and early intervention.