Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
Department of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany.
Kidney Blood Press Res. 2023;48(1):424-435. doi: 10.1159/000529690. Epub 2023 Jun 26.
The ongoing COVID-19 pandemic is placing an extraordinary burden on our health care system with its limited resources. Accurate triage of patients is necessary to ensure medical care for those most severely affected. In this regard, biomarkers could contribute to risk evaluation. The aim of this prospective observational clinical study was to assess the relationship between urinary N-terminal pro-brain natriuretic peptide (NT-proBNP) and acute kidney injury (AKI) as well as severe disease in patients with COVID-19.
125 patients treated with an acute respiratory infection in the emergency department of the University Hospital Regensburg were analyzed. These patients were divided into a COVID-19 cohort (n = 91) and a cohort with infections not caused by severe acute respiratory syndrome-coronavirus-2 (n = 34). NT-proBNP was determined from serum and fresh urine samples collected in the emergency department. Clinical endpoints were the development of AKI and a composite one consisting of AKI, intensive care unit admission, and in-hospital death.
11 (12.1%) COVID-19 patients developed AKI during hospitalization, whereas 15 (16.5%) reached the composite endpoint. Urinary NT-proBNP was significantly elevated in COVID-19 patients who suffered AKI or reached the composite endpoint (each p < 0.005). In a multivariate regression analysis adjusted for age, chronic kidney disease, chronic heart failure, and arterial hypertension, urinary NT-proBNP was identified as independent predictor of AKI (p = 0.017, OR = 3.91 [CI: 1.28-11.97] per standard deviation [SD]), as well as of the composite endpoint (p = 0.026, OR 2.66 [CI: 1.13-6.28] per SD).
Urinary NT-proBNP might help identify patients at risk for AKI and severe disease progression in COVID-19.
当前的 COVID-19 大流行对我们的医疗系统造成了巨大压力，因为医疗系统资源有限。准确地对患者进行分诊是确保对受影响最严重的患者进行医疗护理的必要条件。在这方面，生物标志物可以帮助进行风险评估。本前瞻性观察性临床研究的目的是评估 COVID-19 患者尿液中 N 末端脑利钠肽前体（NT-proBNP）与急性肾损伤（AKI）和重症疾病之间的关系。
分析了在雷根斯堡大学医院急诊科接受急性呼吸道感染治疗的 125 名患者。这些患者被分为 COVID-19 队列（n = 91）和非严重急性呼吸综合征冠状病毒 2 引起的感染队列（n = 34）。在急诊科采集血清和新鲜尿液样本以测定 NT-proBNP。临床终点是 AKI 的发展以及由 AKI、入住重症监护病房和院内死亡组成的复合终点。
住院期间 COVID-19 患者中有 11 名（12.1%）发生 AKI，而有 15 名（16.5%）达到复合终点。发生 AKI 或达到复合终点的 COVID-19 患者尿液中的 NT-proBNP 显著升高（均 p < 0.005）。在调整年龄、慢性肾脏病、慢性心力衰竭和高血压后进行的多变量回归分析中，尿液 NT-proBNP 被确定为 AKI 的独立预测因素（p = 0.017，OR = 3.91 [95%CI：1.28-11.97]，每标准差 [SD]），也是复合终点的独立预测因素（p = 0.026，OR = 2.66 [95%CI：1.13-6.28]，每 SD）。
尿液 NT-proBNP 可能有助于识别 COVID-19 患者中 AKI 和严重疾病进展的风险。
