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Article

Validation of a Prospective Urinalysis-Based Prediction Model for ICU Resources and Outcome of COVID-19 Disease: A Multicenter Cohort Study

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Clinic for Nephrology and Rheumatology, University Medical Center Göttingen, 37075 Göttingen, Germany
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Clinic of Anaesthesiology, University Medical Center Göttingen, 37075 Göttingen, Germany
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Division of Nephrology and Clinical Immunology, RWTH Aachen University, 52074 Aachen, Germany
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III. Department of Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
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Department of Medicine I, Nephrology, Transplantation and Medical Intensive Care, University Witten/Herdecke Medical Center Cologne-Merheim, 51109 Cologne, Germany
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Department of Pneumology and Critical Care Medicine, University Witten/Herdecke, Medical Center Cologne-Merheim, 51109 Cologne, Germany
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Department of Pneumology and Intensive Care Medicine, Medical Clinic V, RWTH Aachen University, 52074 Aachen, Germany
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Department of Intensive Care, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
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I. Department of Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
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Institute of Infection Control and Infectious Diseases, University Medical Center Göttingen, 37075 Göttingen, Germany
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Department of Medical Statistics, University Medical Center Göttingen, 37075 Göttingen, Germany
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Emergency Department, University Medical Center Göttingen, 37075 Göttingen, Germany
*
Author to whom correspondence should be addressed.
Contributed equally (first authorship).
For the COVAS registry.
§
Contributed equally (senior authorship).
Academic Editors: Frank Friedersdorff and Matthias D. Hofer
J. Clin. Med. 2021, 10(14), 3049; https://doi.org/10.3390/jcm10143049
Received: 26 May 2021 / Revised: 22 June 2021 / Accepted: 5 July 2021 / Published: 9 July 2021
In COVID-19, guidelines recommend a urinalysis on hospital admission as SARS-CoV-2 renal tropism, post-mortem, was associated with disease severity and mortality. Following the hypothesis from our pilot study, we now validate an algorithm harnessing urinalysis to predict the outcome and the need for ICU resources on admission to hospital. Patients were screened for urinalysis, serum albumin (SA) and antithrombin III activity (AT-III) obtained prospectively on admission. The risk for an unfavorable course was categorized as (1) “low”, (2) “intermediate” or (3) “high”, depending on (1) normal urinalysis, (2) abnormal urinalysis with SA ≥ 2 g/dL and AT-III ≥ 70%, or (3) abnormal urinalysis with SA or AT-III abnormality. Time to ICU admission or death served as the primary endpoint. Among 223 screened patients, 145 were eligible for enrollment, 43 falling into the low, 84 intermediate, and 18 into high-risk categories. An abnormal urinalysis significantly elevated the risk for ICU admission or death (63.7% vs. 27.9%; HR 2.6; 95%-CI 1.4 to 4.9; p = 0.0020) and was 100% in the high-risk group. Having an abnormal urinalysis was associated with mortality, a need for mechanical ventilation, extra-corporeal membrane oxygenation or renal replacement therapy. In conclusion, our data confirm that COVID-19-associated urine abnormalities on admission predict disease aggravation and the need for ICU (ClinicalTrials.gov number NCT04347824). View Full-Text
Keywords: COVID-19; ICU resources; risk stratification; clinical outcomes; preventive measures; acute kidney injury COVID-19; ICU resources; risk stratification; clinical outcomes; preventive measures; acute kidney injury
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MDPI and ACS Style

Gross, O.; Moerer, O.; Rauen, T.; Böckhaus, J.; Hoxha, E.; Jörres, A.; Kamm, M.; Elfanish, A.; Windisch, W.; Dreher, M.; Floege, J.; Kluge, S.; Schmidt-Lauber, C.; Turner, J.-E.; Huber, S.; Addo, M.M.; Scheithauer, S.; Friede, T.; Braun, G.S.; Huber, T.B.; Blaschke, S. Validation of a Prospective Urinalysis-Based Prediction Model for ICU Resources and Outcome of COVID-19 Disease: A Multicenter Cohort Study. J. Clin. Med. 2021, 10, 3049. https://doi.org/10.3390/jcm10143049

AMA Style

Gross O, Moerer O, Rauen T, Böckhaus J, Hoxha E, Jörres A, Kamm M, Elfanish A, Windisch W, Dreher M, Floege J, Kluge S, Schmidt-Lauber C, Turner J-E, Huber S, Addo MM, Scheithauer S, Friede T, Braun GS, Huber TB, Blaschke S. Validation of a Prospective Urinalysis-Based Prediction Model for ICU Resources and Outcome of COVID-19 Disease: A Multicenter Cohort Study. Journal of Clinical Medicine. 2021; 10(14):3049. https://doi.org/10.3390/jcm10143049

Chicago/Turabian Style

Gross, Oliver, Onnen Moerer, Thomas Rauen, Jan Böckhaus, Elion Hoxha, Achim Jörres, Matthias Kamm, Amin Elfanish, Wolfram Windisch, Michael Dreher, Juergen Floege, Stefan Kluge, Christian Schmidt-Lauber, Jan-Eric Turner, Samuel Huber, Marylyn M. Addo, Simone Scheithauer, Tim Friede, Gerald S. Braun, Tobias B. Huber, and Sabine Blaschke. 2021. "Validation of a Prospective Urinalysis-Based Prediction Model for ICU Resources and Outcome of COVID-19 Disease: A Multicenter Cohort Study" Journal of Clinical Medicine 10, no. 14: 3049. https://doi.org/10.3390/jcm10143049

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