TY - JOUR
T1 - Prognostic Significance of Urinary Biomarkers in Patients Hospitalized With COVID-19
AU - the TRIKIC Consortium Investigators
AU - Menez, Steven
AU - Moledina, Dennis G.
AU - Thiessen-Philbrook, Heather
AU - Wilson, F. Perry
AU - Obeid, Wassim
AU - Simonov, Michael
AU - Yamamoto, Yu
AU - Corona-Villalobos, Celia P.
AU - Chang, Crystal
AU - Garibaldi, Brian T.
AU - Clarke, William
AU - Farhadian, Shelli
AU - Dela Cruz, Charles
AU - Coca, Steven G.
AU - Parikh, Chirag R.
AU - Ko, Albert
AU - Iwasaki, Akiko
AU - Nelson, Allison
AU - Casanovas-Massana, Arnau
AU - White, Elizabeth B.
AU - Schulz, Wade
AU - Coppi, Andreas
AU - Young, Patrick
AU - Nunez, Angela
AU - Shepard, Denise
AU - Matos, Irene
AU - Strong, Yvette
AU - Anastasio, Kelly
AU - Brower, Kristina
AU - Kuang, Maxine
AU - Chiorazzi, Michael
AU - Bermejo, Santos
AU - Vijayakumar, Pavithra
AU - Geng, Bertie
AU - Fournier, John
AU - Minasyan, Maksym
AU - Muenker, M. Catherine
AU - Moore, Adam J.
AU - Nadkarni, Girish
N1 - Publisher Copyright:
© 2021 National Kidney Foundation, Inc.
PY - 2022/2
Y1 - 2022/2
N2 - 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.
AB - 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.
KW - Acute kidney injury (AKI)
KW - COVID-19 prognosis
KW - chronic kidney disease (CKD)
KW - coronavirus disease 2019 (COVID-19)
KW - death
KW - dialysis
KW - epidermal growth factor (EGF)
KW - inflammatory marker
KW - kidney injury molecule 1 (KIM-1)
KW - monocyte chemoattractant protein 1 (MCP-1)
KW - neutrophil gelatinase-associated lipocalin (NGAL)
KW - severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
KW - subclinical AKI
KW - tubular injury
KW - urinalysis
KW - urinary biomarkers
KW - urine microscopy
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U2 - 10.1053/j.ajkd.2021.09.008
DO - 10.1053/j.ajkd.2021.09.008
M3 - Article
C2 - 34710516
AN - SCOPUS:85121222136
SN - 0272-6386
VL - 79
SP - 257-267.e1
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 2
ER -