Background: We aimed to analyze clinical characteristics and find potential factors to predict poor prognosis in patients with coronavirus disease 2019 (COVID-19). Methods: We analyzed the clinical characteristics and laboratory tests of COVID-19 patients and detected SARS-CoV-2 RNA in urine sediments collected from 53 COVID-19 patients enrolled in Renmin Hospital of Wuhan University from 31 January 2020 to 18 February 2020 with qRT-PCR analysis. Then, we classified those patients based on clinical conditions (severe or non-severe syndrome) and urinary SARS-CoV-2 RNA (U RNA − or U RNA + ). Results: We found that COVID-19 patients with severe syndrome (severe patients) showed significantly higher positive rate (11 of 23, 47.8%) of urinary SARS-CoV-2 RNA than non-severe patients (4 of 30, 13.3%, p = 0.006). U RNA + patients or severe U RNA + subgroup exhibited higher prevalence of inflammation and immune discord, cardiovascular diseases, liver damage and renal dysfunction, and higher risk of death than U RNA − patients. To understand the potential mechanisms underlying the viral urine shedding, we performed renal histopathological analysis on postmortems of patients with COVID-19 and found severe renal vascular endothelium lesion characterized by an increase of the expression of thrombomodulin and von Willebrand factor, markers to assess the endothelium dysfunction. We proposed a theoretical and mathematic model to depict the potential factors that determine the urine shedding of SARS-CoV-2. Conclusions: This study indicated that urinary SARS-CoV-2 RNA detected in urine specimens can be used to predict the progression and prognosis of COVID-19 severity.
【저자키워드】 COVID-19, SARS-CoV-2, Endothelium, Renal pathology, Indicator, 【초록키워드】 coronavirus disease, Inflammation, Prognosis, Clinical characteristics, COVID-19 severity, cardiovascular diseases, progression, immune, RNA, Prevalence, Wuhan, Patient, von Willebrand factor, death, Urine, SARS-CoV-2 RNA, university, expression, positive rate, patients, predict, marker, Liver damage, Analysis, COVID-19 patient, Laboratory test, dysfunction, Vascular endothelium, Factor, higher risk, severe patients, potential mechanism, specimen, syndrome, poor prognosis, renal dysfunction, Renmin Hospital, clinical condition, renal, qRT-PCR analysis, enrolled, analyzed, performed, collected, indicated, exhibited, characterized, can be used, determine, significantly higher, histopathological, non-severe patient, patients with COVID-19, 【제목키워드】 SARS-CoV-2 RNA, urinary,