Abstract
We hypothesized that the spread of SARS-CoV-2 in urine during a severe COVID-19 infection may be the expression of the worsening disease evolution. Therefore, the aim of this study was to verify if the COVID-19 disease severity is related to the viral presence in urine samples. We evaluated the clinical evolution in acute COVID-19 patients admitted in the sub-intensive care and intensive care units between 28 of December 2020 and 15th of February 2021 and being positive for SARS-CoV-2 RNA in the respiratory tract, including repeated endotracheal aspirates (ETA), sputum, nasopharyngeal swabs (NPS) and urine. We found that those subjects with SARS-COV-2 in the urine at admittance (8 out of 60 eligible patients) had a more severe disease than those with negative SARS-CoV-2 in urine. Further, they showed an increase in fibrinogen and (C-reactive Protein) CRP serum levels, requiring mechanic ventilation. Of those with positive SARS-CoV-2 in the urine, 50% died. According to our preliminary results, it seems that the presence of SARS-CoV-2 in the urine characterizes patients with a more severe disease and is also related to a higher death rate.
Highlights
Since the very early phase of pandemic, the SARS-CoV-2 infection (COVID-19) showed to be a serious challenge to public health and, while persisting, continues to underline the emergency it represents [1]
While rRT-PCR by a nasopharyngeal swab is a well-defined method for the diagnosis of COVID19, little data exist to assess the role of positive rRT-PCR in other biologic samples and its possible correlation with the disease severity and infectiousness to others [8,9,10]
The idea that viral shedding in the urine could be the expression of systemic involvement of the infection has been previously found in other viral disease and more recently in COVID-19 too [18]
Summary
Since the very early phase of pandemic, the SARS-CoV-2 infection (COVID-19) showed to be a serious challenge to public health and, while persisting, continues to underline the emergency it represents [1]. COVID-19, as previously suggested, which shows systemic involvement [13], is characterized by endothelium damage with an increase in fibrinogen serum levels [14] and is correlated to a worse prognosis [14,15,16]. According to this evidence, we hypothesized that the inflammatory endothelial damage may determine viral shedding in urine and be an expression of a further worsening systemic dissemination of SARS-CoV-2, possibly with a worse outcome [17]. The aim of this study was to verify if COVID-19 disease severity in patients admitted to our hospital is related to the viral presence in urine samples with a systemic inflammatory response too
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