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As a growing amount of evidence was developed about COVID-19 in the recent pandemic period, it became clear that obesity is linked to more severe outcomes and multiple complications in COVID-19 patients, including renal dysfunction. Obese individuals with COVID-19 might be at an increased risk for kidney injury due to various reasons, including systemic inflammation, associated comorbidities, renal hemodynamics and also direct COVID-19 infection. The present study aims to evaluate the association of kidney injury biomarkers with obesity and verify the relation of those parameters with worse prognosis in severe cases of COVID-19.
A observational, prospective study with 91 severe cases of unvaccinated COVID-19 patients between 2020 and 2021 was performed. Medical records with admission and time of hospital stay data were evaluated, as well as clinical data, laboratory parameters, kidney parameters (proteinuria, albuminuria, creatinine and urea) and outcomes such as dialysis needed, invasive ventilatory support and death. Moreover, kidney biomarkers (NGAL, KIM-1, MCP-1 and Nephrin), and endothelial biomarkers (VCAM-1, Angiopoietins, syndecan-1) were evaluated using ELISA assays.
In total, 23 out of the 91 patients (25%) with severe COVID-19 had obesity. The obesity was associated with younger patients, comorbidities presence, and with dialysis needed. No association was observed with death. The analysis regarding most of the laboratorial data, including traditional kidney biomarkers, hematological, hepatic and coagulation parameters, found no statistically significant association. On the other hand, there were statistically significant increases in urinary MCP-1 and VCAM-1 associated to the obese group. In a multivariate approach, it was verified that age was an independent factor for dialysis needed, and that urinary MCP-1 and age were factors for death.
Obesity was associated with increased levels of glomerular injury biomarkers in patients with severe COVID-19.