Angiopoietin-1 as a marker of endothelial dysfunction and a risk factor for acute kidney injury in patients with COVID-19: retrospective cohort study

Abstract

Recently, data have been published on the leading role of endothelial dysfunction in the development of severe COVID-19, including acute renal failure (AKI) and poor prognosis in this group of patients.Aim. To define the role of angiopoetin-1(Ang-1) as a marker of endothelial dysfunction in development of AKI in patients, hospitalized with COVID-19.Materials and methods. 76 patients with confirmed coronavirus infection were included in the study. AKI was diagnosed according to KDIGO 2012 criteria in 44 patients (group 1), 32 patients without sings of kidney disfunction were in group 2. Beside standard clinical and laboratory markers on admission we evaluated serum Ang-1 level with ELISA. We used regression analysis for AKI risk factors evaluation, we calculated odds ratio (OR) and 95% confidence intervals (CI). We used Cox regression for evaluation of risk of death.Results. The serum level of angiopoietin-1 was significantly higher in patients with COVID-19 with AKI: 1.8 (1.5; 2.1) ng/ml vs 1.58 (1.29; 1.7) ng/ml in group 2, р < 0.01. In deceased patients, the level of Ang-1 at admission was significantly higher than in patients who was discharged: 1.91 (1.71; 2.32) ng/ml vs 1.58 (1.34; 1.67) ng/ml, respectively, p = 0.0001. In unifactorial regression analysis we confirmed, that increase of serum Ang-1 level >1.66 ng/ml on admission is the risk factor for AKI development in patients with COVID-19 (OR 5.7, 95% CI 1.7–19.1, р < 0.01). In Cox regression development of AKI increased the absolute risk of death: Hazard ratio = 5.159 (95% CI 1.839–14.469), p = 0.002.Conclusion. The high serum level of Ang-1 in patients with COVID-19 at hospital admission is the marker of systemic endothelial dysfunction and the risk factor for AKI and poor prognosis.