Tian Maoqing, Zhang Lu, Zhu Kai, Shen Bo, Wang Gang, Song Yuan, Chen Cheng, Liang Wei, Guan Yang, Ding Guohua, Lei Tiechi, Li Xiaogang, Xie Jingyuan, Tong Yongqing, Wang Huiming
Renmin Hospital of Wuhan University: Wuhan University Renmin Hospital.
Guangzhou Military Command General Hospital: People's Liberation Army General Hospital of Southern Theatre Command.
Res Sq. 2021 Feb 18:rs.3.rs-203728. doi: 10.21203/rs.3.rs-203728/v1.
We aimed to analyse clinical characteristics and find potential factors predicting poor prognosis in patients with coronavirus disease 2019 (COVID-19). We analyzed the demographic and clinical data 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 January 31, 2020 to February 18, 2020 with qRT-PCR analysis, and then classified those patients based on clinical conditions (severe or non-severe syndrome) and urinary SARS-CoV-2 RNA (U or U ). 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 patients or severe U subgroup exhibited higher prevalence of inflammation and immune discord, cardiovascular diseases, liver damage and renal disfunction, and higher risk of death than U 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 that severe renal vascular endothelium lesion characterized by 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 determining the urine shedding of SARS-CoV-2. 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.
我们旨在分析2019年冠状病毒病（COVID-19）患者的临床特征，并找出预测其预后不良的潜在因素。我们分析了COVID-19患者的人口统计学和临床数据，并采用定量逆转录聚合酶链反应（qRT-PCR）分析法检测了2020年1月31日至2020年2月18日在武汉大学人民医院收治的53例COVID-19患者尿液沉淀物中的严重急性呼吸综合征冠状病毒2（SARS-CoV-2）RNA，然后根据临床状况（重症或非重症综合征）和尿液SARS-CoV-2 RNA（尿阳或尿阴）对这些患者进行分类。我们发现，重症综合征COVID-19患者（重症患者）尿液SARS-CoV-2 RNA阳性率（23例中的11例，47.8%）显著高于非重症患者（30例中的4例，13.3%，p = 0.006）。尿阳患者或重症尿阳亚组炎症和免疫失调、心血管疾病、肝损伤及肾功能不全的患病率更高，死亡风险也高于尿阴患者。为了解病毒尿液排泄的潜在机制，我们对COVID-19患者的尸检组织进行了肾脏组织病理学分析，发现以血栓调节蛋白和血管性血友病因子表达增加为特征的严重肾血管内皮病变，这两种蛋白是评估内皮功能障碍的标志物。我们提出了一个理论和数学模型来描述决定SARS-CoV-2尿液排泄的潜在因素。本研究表明，尿液标本中检测到的尿液SARS-CoV-2 RNA可用于预测COVID-19病情的进展和预后。
