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

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).

[1]  U. Janssens,et al.  Clinical practice guideline: Recommendations on in-hospital treatment of patients with COVID-19 , 2021 .

[2]  A. Vijayan,et al.  SARS-CoV-2 in the kidney: bystander or culprit? , 2020, Nature Reviews Nephrology.

[3]  C. Seymour A cooperation of the doves , 2020, Intensive Care Medicine.

[4]  Victor G. Puelles,et al.  SARS-CoV-2 renal tropism associates with acute kidney injury , 2020, The Lancet.

[5]  R. Busse,et al.  Case characteristics, resource use, and outcomes of 10 021 patients with COVID-19 admitted to 920 German hospitals: an observational study , 2020, The Lancet Respiratory Medicine.

[6]  Jennifer L. Bell,et al.  Effect of Dexamethasone in Hospitalized Patients with COVID-19: Preliminary Report , 2020, medRxiv.

[7]  M. Aepfelbacher,et al.  Dying with SARS-CoV-2 infection—an autopsy study of the first consecutive 80 cases in Hamburg, Germany , 2020, International Journal of Legal Medicine.

[8]  Axel Haverich,et al.  Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19. , 2020, The New England journal of medicine.

[9]  Victor G. Puelles,et al.  Multiorgan and Renal Tropism of SARS-CoV-2 , 2020, The New England journal of medicine.

[10]  O. Moerer,et al.  COVID-19-associated nephritis: early warning for disease severity and complications? , 2020, The Lancet.

[11]  G. Remuzzi,et al.  Adaptations and Lessons in the Province of Bergamo , 2020, The New England journal of medicine.

[12]  P. Welling,et al.  Acute Kidney Injury in COVID-19: Emerging Evidence of a Distinct Pathophysiology. , 2020, Journal of the American Society of Nephrology : JASN.

[13]  Mickaël Ohana,et al.  High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study , 2020, Intensive Care Medicine.

[14]  Yi Wang,et al.  Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial , 2020, The Lancet.

[15]  Ying Yao,et al.  Renal Involvement and Early Prognosis in Patients with COVID-19 Pneumonia. , 2020, Journal of the American Society of Nephrology : JASN.

[16]  Eun Ji Kim,et al.  Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. , 2020, JAMA.

[17]  Holger Moch,et al.  Endothelial cell infection and endotheliitis in COVID-19 , 2020, The Lancet.

[18]  Nathaniel Hupert,et al.  Clinical Characteristics of Covid-19 in New York City , 2020, The New England journal of medicine.

[19]  Hongliang Li,et al.  The Science Underlying COVID-19: Implications for the Cardiovascular System. , 2020, Circulation.

[20]  G. Heinze,et al.  Prediction models for diagnosis and prognosis of covid-19: systematic review and critical appraisal , 2020, BMJ.

[21]  Yan Peng,et al.  Effectiveness of convalescent plasma therapy in severe COVID-19 patients , 2020, Proceedings of the National Academy of Sciences.

[22]  Dengju Li,et al.  Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy , 2020, Journal of Thrombosis and Haemostasis.

[23]  A. Davis,et al.  Management of Critically Ill Adults With COVID-19. , 2020, JAMA.

[24]  Ezekiel J Emanuel,et al.  Fair Allocation of Scarce Medical Resources in the Time of Covid-19. , 2020, The New England journal of medicine.

[25]  Yuan Wei,et al.  A Trial of Lopinavir–Ritonavir in Adults Hospitalized with Severe Covid-19 , 2020, The New England journal of medicine.

[26]  Yi Yang,et al.  Lower mortality of COVID-19 by early recognition and intervention: experience from Jiangsu Province , 2020, Annals of Intensive Care.

[27]  Xin Zhou,et al.  Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China , 2020, The Journal of Emergency Medicine.

[28]  J. Xiang,et al.  Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study , 2020, The Lancet.

[29]  P. Mehta,et al.  COVID-19: consider cytokine storm syndromes and immunosuppression , 2020, The Lancet.

[30]  K. Yuen,et al.  Clinical Characteristics of Coronavirus Disease 2019 in China , 2020, The New England journal of medicine.

[31]  Zunyou Wu,et al.  Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. , 2020, JAMA.

[32]  R. Balk,et al.  Role of Antithrombin III and Tissue Factor Pathway in the Pathogenesis of Sepsis. , 2020, Critical care clinics.

[33]  Ting Yu,et al.  Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study , 2020, The Lancet.

[34]  G. Gao,et al.  A Novel Coronavirus from Patients with Pneumonia in China, 2019 , 2020, The New England journal of medicine.

[35]  Y. Hu,et al.  Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China , 2020, The Lancet.

[36]  Richard D Riley,et al.  Prediction models for diagnosis and prognosis of covid-19 infection: systematic review and critical appraisal , 2020 .

[37]  M. Chandra Idiopathic nephrotic syndrome in children , 1982 .