Validation of a Prospective Urinalysis-Based Prediction Model for ICU Resources and Outcome of COVID-19 Disease: A Multicenter Cohort Study.

Oliver Groß ,Tobias B Huber,Marylyn M Addo,Stefan Kluge,Wolfram Windisch,Matthias Kamm,Thomas Rauen,Onnen Moerer,Amin Elfanish,Jan Böckhaus,Jan-Eric Turner,Juergen Floege,Gerald S Braun,Christian Schmidt-Lauber,Samuel Huber,Tim Friede,Simone Scheithauer,Michael Dreher,Achim Jörres,Elion Hoxha,Sabine Blaschke

doi:10.3390/jcm10143049

Abstract

In COVID-19, guidelines recommend a urinalysis on hospital admission as SARS-CoV-2 renal tropism, post-mortem, was associated with disease severity and mortality. Following the hypothesis from our pilot study, we now validate an algorithm harnessing urinalysis to predict the outcome and the need for ICU resources on admission to hospital. Patients were screened for urinalysis, serum albumin (SA) and antithrombin III activity (AT-III) obtained prospectively on admission. The risk for an unfavorable course was categorized as (1) “low”, (2) “intermediate” or (3) “high”, depending on (1) normal urinalysis, (2) abnormal urinalysis with SA ≥ 2 g/dL and AT-III ≥ 70%, or (3) abnormal urinalysis with SA or AT-III abnormality. Time to ICU admission or death served as the primary endpoint. Among 223 screened patients, 145 were eligible for enrollment, 43 falling into the low, 84 intermediate, and 18 into high-risk categories. An abnormal urinalysis significantly elevated the risk for ICU admission or death (63.7% vs. 27.9%; HR 2.6; 95%-CI 1.4 to 4.9; p = 0.0020) and was 100% in the high-risk group. Having an abnormal urinalysis was associated with mortality, a need for mechanical ventilation, extra-corporeal membrane oxygenation or renal replacement therapy. In conclusion, our data confirm that COVID-19-associated urine abnormalities on admission predict disease aggravation and the need for ICU (ClinicalTrials.gov number NCT04347824).

Highlights

Coronavirus 2019 disease (COVID-19) is initiated by infection of the upper respiratory tract with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1,2]
We found that early on, abnormalities of the urine, serum albumin and antithrombin III (AT-III) were associated with worse outcomes of COVID-19
30% of this group showed a decline in their serum albumin to the high-risk category during their hospital stay and AT-III activity fell in 40% below the critical cut-off of 70% (Figure 3)

Summary

Introduction

Coronavirus 2019 disease (COVID-19) is initiated by infection of the upper respiratory tract with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1,2]. Major mechanisms of the disease comprise viral replication in multiple organs, including the kidney and involving multiple cell types, vascular endotheliitis, thrombosis, and systemic cytokine storm [3,4,5,6,7,8,9]. Clinical identification of such patients could improve allocation of medical resources and, the outcome [18]. We found that early on, abnormalities of the urine, serum albumin and antithrombin III (AT-III) were associated with worse outcomes of COVID-19. We proposed the hypothesis in The Lancet that these markers may serve to indicate kidney involvement and loss of important proteins to construct a prediction tool for COVID-19 severity [19]. We present the multicenter cohort validation study (NCT04347824) of this hypothesis

Methods

Results

Discussion

Conclusion