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Abstract
Kidney function is affected in COVID-19, while kidney itself modulates the immune response. Here, hypothesize if COVID-19 urine biomarkers level can assess immune activation vs. clinical trajectory. Considering the kidney’s critical role in modulating the immune response, we sought to analyze activation markers in patients with pre-existing dysfunction. This was a cross-sectional study of 68 patients. Blood and urine were collected within 48 h of hospital admission (H1), followed by 96 h (H2), seven days (H3), and up to 25 days (H4) from admission. Serum level ferritin, procalcitonin, IL-6 assessed immune activation overall, while the response to viral burden was gauged with serum level of spike protein and αspike IgM and IgG. 39 markers correlated highly between urine and blood. Age and race, and to a lesser extend gender, differentiated several urine markers. The burden of pre-existing conditions correlated with urine DCN, CAIX and PTN, but inversely with IL-5 or MCP-4. Higher urinary IL-12 and lower CAIX, CCL23, IL-15, IL-18, MCP-1, MCP-3, MUC-16, PD-L1, TNFRS12A, and TNFRS21 signified non-survivors. APACHE correlated with urine TNFRS12, PGF, CAIX, DCN, CXCL6, and EGF. Admission urine LAG-3 and IL-2 predicted death. Pre-existing kidney disease had a unique pattern of urinary inflammatory markers. Acute kidney injury was associated, and to a certain degree, predicted by IFNg, TWEAK, MMP7, and MUC-16. Remdesavir had a more profound effect on the urine biomarkers than steroids. Urinary biomarkers correlated with clinical status, kidney function, markers of the immune system activation, and probability of demise in COVID-19.
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1 The University of Pennsylvania, Department of Anesthesiology and Critical Care, Philadelphia, USA (GRID:grid.25879.31) (ISNI:0000 0004 1936 8972); The University of Pennsylvania, Leonard Davis Institute for Healthcare Economics, Philadelphia, USA (GRID:grid.25879.31) (ISNI:0000 0004 1936 8972)
2 Drexel University, School of Biomedical Engineering, Science and Health Systems, Philadelphia, USA (GRID:grid.166341.7) (ISNI:0000 0001 2181 3113)
3 Widener University, School of Nursing, Philadelphia, USA (GRID:grid.268247.d) (ISNI:0000 0000 9138 314X)
4 Drexel University, College of Arts and Sciences, Philadelphia, USA (GRID:grid.166341.7) (ISNI:0000 0001 2181 3113)
5 The University of Pennsylvania, Department of Genetics, Perelman School of Medicine, Philadelphia, USA (GRID:grid.25879.31) (ISNI:0000 0004 1936 8972)
6 The University of Pennsylvania, Department of Genetics, Perelman School of Medicine, Philadelphia, USA (GRID:grid.25879.31) (ISNI:0000 0004 1936 8972); The University of Pennsylvania, Division of Renal Electrolyte and Hypertension, Department of Medicine, Philadelphia, USA (GRID:grid.25879.31) (ISNI:0000 0004 1936 8972)