COVID-19: early warning signs for severe disease courses

The number of people infected with the novel Coronavirus SARS-CoV-2, no longer rising as strongly as a few weeks ago. Not all persons infected with the pathogen, fall ill. But there are also serious disease that is often fatal. A new urine test is now to help, at an early stage to find out who has a high risk for it.

“The courses of the disease are nonspecific, diverse and vary greatly, from asymptomatic gradients to severe pneumonia with respiratory failure and death,” writes the Robert Koch Institute (RKI) to the sequences of the Coronavirus-disease-2019 (COVID-19). High age and obesity apply gradients as important risk factors for severe disease. However, in the case of younger or non-overweight individuals, the infection can have a dramatic impact. A urine test could help early to determine who that is.

Life-threatening deterioration prevent losses and deaths

According to a recent communication from the University medical center Göttingen (UMG) have professionals in the UMG developed an action path for the early detection and treatment of severe cases in COVID-19 infections.

Therefore, a simple urine test will help the medical professionals the early warning signs for an impending severe course of the COVID to detect 19 disease.

So on the basis of a few parameters, it can be days, even before lung and other organs are failing hard, with the treatment of complications threatened to be started. Many of the Sufferers were so threatening to the deterioration of life prevent losses and deaths.

The findings of the scientists were published as “Correspondence” in the prestigious journal “The Lancet” online.

The improvement of patient care at COVID-19 infection

Whether and how the proposed action path can contribute to the improvement of patient care at COVID-19 infections, is currently being investigated in the context of a large, interventional observational study with the title “Covid-19-associated Nephritis as a predictor for the disease severity and complications” with the participation of several University clinics in Germany.

In the case of inpatient treatment of COVID-19 infections, the Team from the UMG was noticed that, especially in the critically ill – in addition to the lungs and heart at an early stage, the kidneys are affected.

The Doctors of the UMG had begun to evaluate their findings with experts from the University medical center Hamburg-Eppendorf and other German University clinics and to discuss with experts from Italy, China, England and the USA.

Current Gewebsuntersuchungen of the deceased to support the assumption that, because of the dramatic nature of the disease of the other organs in the early kidney involvement so far has been neglected.

Life-threatening loss of blood components

If in the urine of the suspected COVID-19-associated inflammation of the kidneys (Nephritis) exists, it follows in the path of the UMG, the provision of only three simple parameters: Albumin in blood, Albumin in the urine, and Antithrombin III.

These three parameters are used together with the urine findings, to diagnose the so-called “capillary leak syndrome”. As the communication explains, this is a life-threatening loss of blood constituents and protein from the blood in the (lungs)tissue by a from Virus-induced General leakage of the small blood vessels. On the basis of the three parameters in the risk classification of the patients.

“Is also only one of three parameters, hard to change, there is a high risk that the Diseased to the normal station in a timely manner worse, on the intensive care unit will be transferred to or in the course of intensive care is still deteriorating,” explains the First author of the publication, Prof. Dr. Oliver Gross, a senior physician at the clinic for Nephrology and rheumatology UMG.

What are the technical personnel especially need to pay attention

As stated in the notice, awareness of the action path of the UMG for the early diagnosis of capillary leak syndrome in COVID-19 specialist staff Affected for their Actions at an early stage to critical values in the blood in connection with a COVID-disease-align:

In the case of severe deficiency of Albumin in the blood, interstitial pulmonary edema (water in lungs) develops accordingly. The capillary leakage leads to the loss of Albumin from the blood into the lung tissue, the lung tissue swells, the Breathing and the exchange of oxygen difficult.

According to the experts, the water retention with drainage tablets are treated. Through the early detection of severe albumin deficiency in the blood, the technician will know in time what to look for now is:

• The drainage therapy can start before the deterioration of the breathing.
• The drainage of the drugs will work in the case of albumin deficiency reduces. The drainage, therefore, much higher doses are needed. Or is it already in the past for the removal of water for dialysis must be used to machines, before the lung tissue is running full of water.
• Critical medicines such as antibiotics, can have protein through the altered plasma binding an unexpectedly different concentration of active ingredient. Therefore, as a preventive measure the drug levels should be determined.
• The lack of protein in the blood may lead to cardiovascular failure. Thus, early preventive measures can be taken.

During a severe deficiency of Antithrombin III in the blood, thromboses (clots are in the blood vessels), as well as Thrombembolien (clot to dislodge and clog the lung vessels) as a result.

Blood thinners, such as Heparin, are used prophylactically to prevent thrombosis and Thrombembolien. Through the early recognition of the severe anti-thrombin deficiency in the blood, the professionals know where we were going, what to look for especially is:

• The preventive therapy with Blood thinners, may begin prior to the formation of blood clots.
• The most common Blood thinner Heparin not work properly, because Heparin acts via Antithrombin. Therefore, it needs doses usually significantly higher Heparin, to achieve the desired preventive effect and to prevent blood clots.

“If the findings of the medical teams for the UMG to confirm, this would have a lasting effect. So in the future might be already said in the run-up to the need for treatment on intensive care unit before,“ said the Senior author of the publication, Prof. Dr. Simone Scheithauer, Director of the Institute for hospital hygiene and infectious diseases of the UMG.

“In addition, patients could be earlier and more accurately assigned for special therapies (also in the case of drug trials). Through the early recognition of the systemic capillary leak syndrome-symptomatic, preventive therapies could be initiated and perhaps even threatening life courses be prevented,“ says Prof. Scheithauer.

Also for those Affected in nursing homes suitable

Because of the action path of the UMG begins with a simple urine analysis, and hold the authors, the procedure for COVID-19 groups of patients in nursing homes and it is suitable for those who are treated after diagnosis, initially on an outpatient basis at home.

Here, the urine could serve findings as an early warning that a deterioration in the physical condition threatens. So could be time to use an outpatient measure earlier and further damage, and perhaps even a stay in hospital prevent. (ad)