Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America.
Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America.
PLoS One. 2022 Mar 8;17(3):e0264178. doi: 10.1371/journal.pone.0264178. eCollection 2022.
Renalase is a secreted flavoprotein with anti-inflammatory and pro-cell survival properties. COVID-19 is associated with disordered inflammation and apoptosis. We hypothesized that blood renalase levels would correspond to severe COVID-19 and survival. In this retrospective cohort study, clinicopathologic data and blood samples were collected from hospitalized COVID-19 subjects (March-June 2020) at a single institution tertiary hospital. Plasma renalase and cytokine levels were measured and clinical data abstracted from health records. Of 3,450 COVID-19 patients, 458 patients were enrolled. Patients were excluded if <18 years, or opted out of research. The primary composite outcome was intubation or death within 180 days. Secondary outcomes included mortality alone, intensive care unit admission, use of vasopressors, and CPR. Enrolled patients had mean age 64 years (SD±17), were 53% males, and 48% non-whites. Mean renalase levels was 14,108·4 ng/ml (SD±8,137 ng/ml). Compared to patients with high renalase, those with low renalase (< 8,922 ng/ml) were more likely to present with hypoxia, increased ICU admission (54% vs. 33%, p < 0.001), and cardiopulmonary resuscitation (10% vs. 4%, p = 0·023). In Cox proportional hazard model, every 1000 ng/ml increase in renalase decreased the risk of death or intubation by 5% (HR 0·95; 95% CI 0·91-0·98) and increased survival alone by 6% (HR 0·95; CI 0·90-0·98), after adjusting for socio-demographics, initial disease severity, comorbidities and inflammation. Patients with high renalase-low IL-6 levels had the best survival compared to other groups (p = 0·04). Renalase was independently associated with reduced intubation and mortality in hospitalized COVID-19 patients. Future studies should assess the pathophysiological relevance of renalase in COVID-19 disease.
肾酶是一种具有抗炎和促进细胞存活特性的分泌性黄素蛋白。COVID-19 与炎症失调和细胞凋亡有关。我们假设血液肾酶水平与严重 COVID-19 和存活率相关。在这项回顾性队列研究中，从一家三级医院住院的 COVID-19 患者（2020 年 3 月至 6 月）收集临床病理数据和血液样本。测量血浆肾酶和细胞因子水平，并从病历中提取临床数据。在 3450 例 COVID-19 患者中，有 458 例患者入选。如果患者年龄<18 岁或选择不参与研究，则将其排除在外。主要复合结局是 180 天内插管或死亡。次要结局包括单独死亡、入住重症监护病房、使用升压药和心肺复苏。入组患者的平均年龄为 64 岁（标准差±17），男性占 53%，非白人占 48%。平均肾酶水平为 14108.4ng/ml（标准差±8137ng/ml）。与肾酶水平高的患者相比，肾酶水平低（<8922ng/ml）的患者更有可能出现低氧血症、重症监护病房入院率增加（54%比 33%，p<0.001）和心肺复苏（10%比 4%，p=0.023）。在 Cox 比例风险模型中，肾酶每增加 1000ng/ml，死亡或插管的风险降低 5%（风险比 0.95；95%置信区间 0.91-0.98），单独生存的风险增加 6%（风险比 0.95；95%置信区间 0.90-0.98），调整了社会人口统计学、初始疾病严重程度、合并症和炎症因素后。与其他组相比，肾酶高-IL-6 水平低的患者的生存情况最好（p=0.04）。肾酶与住院 COVID-19 患者的插管和死亡率降低独立相关。未来的研究应评估肾酶在 COVID-19 疾病中的病理生理相关性。
