Background: Acute kidney injury (AKI) is very common in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) disease 2019 (COVID-19) and considered as a risk factor for COVID-19 severity. SARS-CoV-2 renal tropism has been observed in COVID-19 patients, suggesting that direct viral injury of the kidneys may contribute to AKI. We examined 20 adult cases with confirmed SARS-CoV-2 infection requiring ICU supportive care in a single-center prospective observational study and investigated whether urinary markers for viral infection (SARS-CoV-2 N) and shedded cellular membrane proteins (ACE2, TMPRSS2) allow identification of patients at risk for AKI and outcome of COVID-19. Objectives: The objective of the study was to evaluate whether urinary markers for viral infection (SARS-CoV-2 N) and shedded cellular membrane proteins (ACE2, TMPRSS2) allow identification of patients at risk for AKI and outcome of COVID-19. Results: Urinary SARS-CoV-2 N measured at ICU admission identified patients at risk for AKI in COVID-19 (HR 5.9, 95% CI 1.4–26, p = 0.0095 ). In addition, the combination of urinary SARS-CoV-2 N and plasma albumin measurements further improved the association with AKI (HR 11.4, 95% CI 2.7–48, p = 0.0016 ). Finally, combining urinary SARS-CoV-2 N and plasma albumin measurements associated with the length of ICU supportive care (HR 3.3, 95% CI 1.1–9.9, p = 0.0273 ) and premature death (HR 7.6, 95% CI 1.3–44, p = 0.0240 ). In contrast, urinary ACE2 and TMPRSS2 did not correlate with AKI in COVID-19. Conclusions: In conclusion, urinary SARS-CoV-2 N levels associate with risk for AKI and correlate with COVID-19 severity.
【저자키워드】 intensive care, risk prediction, severe acute respiratory syndrome coronavirus-2, Acute kidney injury, SARS-CoV-2 disease 2019, TMPRSS2, 【초록키워드】 COVID-19, SARS-CoV-2, viral infection, ACE2, prospective observational study, SARS-COV-2 infection, severity, COVID-19 severity, risk, outcome, risk factor, ICU, Kidney injury, kidney, Protein, AKI, Patient, albumin, ICU admission, death, plasma, Premature, disease, COVID-19 patients, association, Coronavirus-2, marker, supportive care, Combination, Injury, acute respiratory syndrome, 95% CI, single-center, renal, SARS-CoV-2 N, cellular membrane, urinary, evaluate, examined, addition, investigated, contribute, with COVID-19, 【제목키워드】 COVID-19, SARS-CoV-2, AKI, urinary, Level, Associate,