AUTHOR=Tampe Désirée , Hakroush Samy , Bösherz Mark-Sebastian , Franz Jonas , Hofmann-Winkler Heike , Pöhlmann Stefan , Kluge Stefan , Moerer Onnen , Stadelmann Christine , Ströbel Philipp , Winkler Martin Sebastian , Tampe Björn 

TITLE=Urinary Levels of SARS-CoV-2 Nucleocapsid Protein Associate With Risk of AKI and COVID-19 Severity: A Single-Center Observational Study

JOURNAL=Frontiers in Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.644715

DOI=10.3389/fmed.2021.644715

ISSN=2296-858X

ABSTRACT=<p><bold>Background:</bold> 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.</p><p><bold>Objectives:</bold> 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.</p><p><bold>Results:</bold> 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, <italic>p</italic> = <italic>0.0095</italic>). 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, <italic>p</italic> = <italic>0.0016</italic>). 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, <italic>p</italic> = <italic>0.0273</italic>) and premature death (HR 7.6, 95% CI 1.3–44, <italic>p</italic> = <italic>0.0240</italic>). In contrast, urinary ACE2 and TMPRSS2 did not correlate with AKI in COVID-19.</p><p><bold>Conclusions:</bold> In conclusion, urinary SARS-CoV-2 N levels associate with risk for AKI and correlate with COVID-19 severity.</p>