BackgroundAKI commonly occurs in patients with coronavirus disease 2019 (COVID-19). Its pathogenesis is poorly understood. The urokinase receptor system is a key regulator of the intersection between inflammation, immunity, and coagulation, and soluble urokinase plasminogen activator receptor (suPAR) has been identified as an immunologic risk factor for AKI. Whether suPAR is associated with COVID-19–related AKI is unknown.MethodsIn a multinational observational study of adult patients hospitalized for COVID-19, we measured suPAR levels in plasma samples from 352 adult patients that had been collected within 48 hours of admission. We examined the association between suPAR levels and incident in-hospital AKI.ResultsOf the 352 patients (57.4% were male, 13.9% were black, and mean age was 61 years), 91 (25.9%) developed AKI during their hospitalization, of whom 25 (27.4%) required dialysis. The median suPAR level was 5.61 ng/ml. AKI incidence rose with increasing suPAR tertiles, from a 6.0% incidence in patients with suPAR <4.60 ng/ml (first tertile) to a 45.8% incidence of AKI in patients with suPAR levels >6.86 ng/ml (third tertile). None of the patients with suPAR <4.60 ng/ml required dialysis during their hospitalization. In multivariable analysis, the highest suPAR tertile was associated with a 9.15-fold increase in the odds of AKI (95% confidence interval [95% CI], 3.64 to 22.93) and a 22.86-fold increase in the odds of requiring dialysis (95% CI, 2.77 to 188.75). The association was independent of inflammatory markers and persisted across subgroups.ConclusionsAdmission suPAR levels in patients hospitalized for COVID-19 are predictive of in-hospital AKI and the need for dialysis. SuPAR may be a key component of the pathophysiology of AKI in COVID-19.

Lung recruitment maneuvers markedly reduced cardiac output and left ventricular end-diastolic areas in hemodynamically stable patients following cardiac surgery.

No abstract

Background SARS-CoV-2 strains healthcare capacity. Better risk stratification, with discharge of patients with a predicted mild disease trajectory can ease this burden. Elevated blood soluble urokinase plasminogen activator receptor (suPAR) has previously been shown associated with risk of intubation in confirmed COVID-19 patients. Objective To evaluate if point-of-care measures of suPAR in patients presenting at the emergency department (ED) with symptoms of COVID-19 can identify patients that can be safely discharged. Methods Observational cohort study including all patients in the ED with symptoms of COVID-19 from March 19 th to April 3 rd , 2020. Soluble urokinase plasminogen activator receptor was measured at first presentation. Review of electronic patient records 14 days after admission were used to assess disease trajectory. Primary endpoints were mild, moderate, severe, or very severe trajectory. The predictive value of suPAR, National early warning score (NEWS), C-reactive protein (CRP), and duration of symptoms (DOS) was calculated using receiver operating characteristics (ROC). Results Of 386 patients, 171 (44%) patients had a mild disease trajectory, 79 (20%) a moderate, 63 (16%) a severe, and 73 (19%) a very severe disease trajectory. Low suPAR was a strong marker of mild disease trajectory. Results suggest a cut-off for discharge for suPAR<2.0 ng/ml if suPAR is used as a single parameter, and 3.0 ng/ml when combined with NEWS=<4 and CRP<10 mg/l- Conclusion suPAR is a potential biomarker for triage and safe early discharge of patients with COVID-19 symptoms in the ED. suPAR can be used even before SARS-CoV-2 status is known.