Lower Urinary Tract Signs and Symptoms in COVID-19 infected Patients

Javan Balegh Marand A1, Bach C2, Janssen D3, Heesakkers J3, Ghojazadeh M4, Voegeli T2, Salehi-Pourmehr H4, Mostafae H5, Hajebrahimi S4, Rahnama'i M2

Research Type

Clinical

Abstract Category

Prevention and Public Health

Abstract 486
On Demand Prevention and Public Health
Scientific Open Discussion Session 31
On-Demand
Overactive Bladder New Devices Physiology Infection, other
1. Radboud University Nijmegen , The Netherlands, 2. Uniklinik RWTH Aachen, Germany, 3. Radboud University Nijmegen, The Netherlands, 4. Tabriz Medical University, Iran, 5. Vienna Medical University, Vienna, Austria
Presenter
M

Mohammad Sajjad Rahnama'i

Links

Abstract

Hypothesis / aims of study
Although respiratory symptoms are the predominant presentation of COVID-19 among symptomatic infected patients, it is important to emphasize that multiple organ involvement including the gastrointestinal tract, central nervous system, cardiovascular system, liver, bone marrow and kidney have already been reported in patients infected with SARS-CoV-2. Besides severe lung failure i.e. Acute Respiratory Distress Syndrome (ARDS), heart and kidney failure have been recorded among infected patients. 
Hematuria associated with SARS-CoV-2 infection has also been reported in both adults and children.
Moreover, in both human and animal studies, limited persistence of SARS-COV-2 has been detected .
To date, there have been no studies published on the effect of COVID-19 infection on the lower urinary tract.
Study design, materials and methods
The effect of COVID-19 on lower urinary tract function was studied in a multi-centre study including 238 patients who were admitted with symptoms caused by COVID-19 to the university hospital of Aachen in Germany and Tabriz in Iran. 
In order to record comorbidities (including obesity, arterial hypertension, and existing respiratory disease), symptom onset, and start of hospitalization, medical reports from current and previous hospital stays, as well as self-reported history from non-intubated patients, were used. 
For pathogen diagnosis (viral, bacterial, fungal), bronchoscopy and broncho-alveolar lavage with a total volume of 160 ml was performed in all intubated patients.
A portion of the lavage fluid was prepared for immunocytological analysis. In spontaneously
breathing patients, the sputum obtained was used as sample material. Viral load was determined using real-time polymerase chain reaction (PCR) of respiratory material. The threshold cycle Ct represents the time at which the reaction enters the exponential phase of replication. It is inversely proportional to the viral concentration in patient material and reflects the relative differences in viral load in a logarithmic manner. Threshold cycles for the S-gene <20 were classified as high. Values >30 were considered low viral load; values between 20 and 30 were classified as moderate viral load.
Serum, urine, and stool were also tested for SARS-CoV-2. In addition, urine parameters were recorded over time, such as erythrocyte count (RBC), white blood cell count (WBC) and proteinuria. Descriptive and analytical statistics including chi-square test and Fisher's Exact test was employed using IBM SPSS (version 24). All analyses were considered significant when p<0.05.
Results
None of the patients reported to have any lower urinary tract symptoms. SARS-CoV-2 was found in the urine of 19 % of the tested patients. 
The mortality rate in COVID-19 infected patients with microscopic haematuria together with white blood cells in their urine, was significantly increased from 48% to 61% in the Tabriz cohort (p-value=0.03) and from 30 % to 35% in the Aachen cohort (p-value =0.045). Furthermore, in the group of patients with SARS-CoV-2 urine PCR, the mortality rate rose from 33% to 50%. (p-value =0.039).
In addition, the urine of 63 patients admitted in Aachen, was checked for SARS-CoV-2 presence by PCR. From these patients, 51 were negative (81%) of whom 13 patients died (25,5%). Moreover, 12 patients tested positive for SARS-CoV-2 in their urine (19%). From these 12 patients, 7 patients died (58%). This means that, in the group of patients with SARS-CoV-2 urine PCR, the mortality rate rose from 33% to 50%. (p-value =0.039).
From the total of 238 patients included in our study, 122 patients had a bacterial urine culture of whom 50 patients (41%) had a positive bacterial urine culture. The most common uropathogens were (E. Coli, Klebsiella Pneumoniae and Proteus). The mortality among the patients with a positive bacterial urine culture was 26% (13 patients).
The mortality rate in COVID-19 infected patients with microscopic hematuria together with white blood cells in their urine, was significantly increased from 48% to 61% in the Tabriz cohort (p-value=0.03) and from 30 % to 35% in the Aachen cohort (p-value =0.045), as shown in table 2.
Interpretation of results
Patients admitted with COVID-19 infection did not report to have any lower urinary tract symptoms even those patient who had a positive Urine SARS-CoV-2 PCR.
In addition, hematuria, WBC in urine as well as COVID-19 positivity in urine were found to be strong negative prognostic factors in admitted COVID-19 patients.
Concluding message
We found no lower urinary tract symptoms in patients admitted with COVID-19 infection.
Even the presence of SARS- CoV-2 did not cause any urinary symptoms. It can be concluded that hematuria, WBC in urine as well as COVID-19 positivity in urine are negative prognostic factors in admitted COVID-19 patients.
Figure 1
Figure 2
Disclosures
Funding None Clinical Trial No Subjects Human Ethics Committee Uniklinik RWTH Aachen Helsinki Yes Informed Consent No
17/05/2022 02:07:54