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Kidney Week

Abstract: PO0041

Urinary Epidermal Growth Factor as a Protector in COVID-19 Patients with AKI

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Escamilla-Illescas, David, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
  • Casas-Aparicio, Gustavo Alejandro, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
Background

Acute Kidney Injury (AKI) in hospitalized patients with infection by SARS-Cov-2 (COV-AKI) is a multifactorial syndrome with immune and inflammatory responses. Knowing the cytokine profile will help to understand the pathogenesis.

Methods

Single center, prospective study at the National Institute of Respiratory Diseases (INER), Mexico. Between May-August 2020 we included patients with severe pneumonia by Sars-Cov-2. We collected urine for citokines quantification with a Human Cytokine Magnetic 30-plex panel by Luminex, TIMP-2 and IGFBP7 by ELISA and N-Gal by Architect®. Clinical and laboratory data were gathered from medical file. We evaluated for AKI defined by the 23rd ADQI consensus with [TIMP2]x[IGFBP7] >0.3. We used χ2 and Mann Whitney-U test to compare groups. We calculated the area under the curve (AUC) for EGF, determined the best accuracy cut-off point and correlated EGF with NGAL, [TIMP2]x[IGFBP7] and GFR with a Spearman-rho. We did a univariate and multivariate logistic regression.

Results

We included 51 patients with 53 years-old median age and 58.8% men. Hypertension and D-dimer were higher in the AKI group. In the urinary citokines there were differences for RANTES as risk factor and EGF as protective factor. The analysis was consistent considering all the values and taking out the outliers. The AUC for EGF was 0.788 (p=0.01, 95% CI: 0.59-0.97), with the best accuracy cutoff of 4600 pg/mL. EGF showed correlation with NGAL ρ-0.62 (p<0.01), [TIMP2]x[IGFBP7] ρ-0.71 (p<0.01) and CKD-EPI GFR ρ+0.74 (p<0.01). EGF shows protective effects with statistically differences in the univariate and multivariate logistic regression (Table 1).

Conclusion

Patients without AKI had more expression of uEGF; this cytokine could be involved in the renal protection against the development of COV-AKI. EGF has an inverse correlation with NGAL and [TIMP2]x[IGFBP7] and a positive correlation with the GFR.

Univariate and multivariate analysis for AKI
VariablesUnadjusted OR (95% CI)pAdjusted OR (95% CI)p
Age >60y3.07 (0.82-11.48)0.091.92 (0.28-13.07)0.50
Male2.30 (0.73-7.19)0.153.85 (0.73-20.16)0.11
Hypertension7.87 (1.54-40.27)0.017.27 (0.94-55.82)0.056
NGAL >406.02 (1.71-21.09)0.0054.09 (0.82-20.34)0.08
D-Dimer3.52 (0.82-15-16)0.093.71 (0.49-27.99)0.20
EGF >46000.18 (0.04-0.80)0.020.08 (0.008-0.87)0.03
EGF >4600 w/o outliers0.05 (0.008-0.40)0.0040.095 (0.01-0.81)0.03

CI: Confidence Interval; OR: Odds Ratio; w/o: without

Funding

  • Government Support – Non-U.S.