google-site-verification=JLc_xwGgVJ17GiwZ3wXEpNdMkGhWoNDHVq-rrigYyiQ The Relationship Between Urine Test Findings and Disease Outcomes in Hospitalized Patients With COVID-19 - Iran Journal of Nursing - نشریه پرستاری ایران
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Amerion N, Ebrahimi H, Goli S, Bagheri H, Rouhani M. The Relationship Between Urine Test Findings and Disease Outcomes in Hospitalized Patients With COVID-19. IJN 2025; 38 (S1 ) : 3092.2
URL: http://ijn.iums.ac.ir/article-1-3812-en.html
The Relationship Between Urine Test Findings and Disease Outcomes in Hospitalized Patients With COVID-19
Nafiseh Amerion1 , Hossein Ebrahimi2 , Shahrbanou Goli2 , Hossein Bagheri3 , Marzieh Rouhani2
1- Department of Nursing, School of Medicine, Shahrood Branch, Azad University, Shahrood, Iran.
2- Health-Related Social and Behavioral Sciences Research Center, Shahrood University of Medical Sciences, Shahrood, Iran.
3- Department of Nursing, School of Medicine, Shahrood Branch, Azad University, Shahrood, Iran. , Nafiseh7166.ameriun@yahoo.com
Keywords: COVID-19, Urine analysis, Hospitalization, Mortality, Intensive care unit, Mechanical ventilation
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Introduction
After severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), COVID-19 is the third common viral disease transmitted between humans and animals that can cause severe respiratory illness. The SARS-CoV-2 virus of COVID-19 is transmitted from person to person through direct contact with infected person or breathing infected droplets. Approximately 81% of patients with COVID-19 exhibit mild symptoms, while 14% present severe symptoms, including pneumonia and shortness of breath. In 5% of cases, the patient’s condition worsens, which is associated with respiratory failure, septic shock and failure of other organs.
The kidneys are organs that can be affected by the coronavirus. To diagnose kidney function and urinary tract diseases, a complete urinalysis is crucial. Studies have shown that renal abnormalities have occurred in several patients with COVID-19, and renal complications associated with the disease are linked to higher mortality rates. The aim of this study was to determine the relationship between the findings of a complete urine test and the disease outcomes in patients with COVID-19 referred to hospital in Shahroud, Iran.

Methods

Participants
This is a descriptive-analytical study with a cross-sectional design. In this study, 1134 records related to the patients with COVID-19 registered in the COVID-19 database of Imam Hossein Hospital affiliated to  Shahroud University of Medical Sciences from March 20, 2020, to June 20, 2021, were examined. In this study, the results of the urine tests were examined in terms of normal and abnormal values and regarding their relationship with the severity of the disease outcomes. Logistic regression analysis, independent and dependent t-tests were used for analysis. The inclusion criteria were: hospitalization in the intensive care unit (ICU) or other departments of the hospital, diagnosis of COVID-19 (positive nasal or nasopharyngeal swabs by RT-PCR test, or based on lung CT scan images showing ground-glass opacities), having complete urine test results (including macroscopic and microscopic urinary parameters and urine culture) extracted from the COVID database of the hospital. The patients with incomplete demographic information or urine test results would be excluded.  

Instruments
A demographic checklist was used to survey age, gender, and underlying diseases. A checklist was used to extract the urine test parameters including urine color, urine appearance, urine pH, urine culture, colony count, mucus in urine, bacteria in urine, protein in urine, pus in urine, blood in urine, sugar in urine, ketones in urine, yeast cells in urine, casts in urine, crystals in urine, epithelial cells, white blood cells, red blood cells, urea in urine, specific gravity of urine, and nitrite in urine. A researcher-made checklist was also to assess disease outcomes including the need for hospitalization in the ICU, the need for invasive mechanical ventilation (IMV), the need for discharge, and death. The outcomes were recorded as “yes” or “no” in the checklist. 

Data analysis
The collected data were categorized and analyzed using SPSS software, version 23 employing both descriptive statistics (frequency, percentage, Mean±SD) and inferential statistics (independent t-test, chi-square test, Fisher’s exact test). Frequency and percentage were used to describe qualitative variables, while mean and standard deviation were utilized for quantitative variables.

Results
The appearance variables, bacteria in urine, blood in urine, urinary casts, crystals in urine, protein in urine, red blood cells in urine, white blood cells in urine, yeast cells in urine, colony count in urine, and positive urine culture showed a significant relationship with death and hospitalization in the ICU (P<0.05). Additionally, the variables of ketones in urine, mucus in urine, and urine specific gravity were significantly related to the intubation in patients with COVID-19 (P<0.05).

Conclusion
The changes in urine test parameters in patients with COVID-19 are associated with the disease outcomes (death, hospitalization in the ICU, intubation). Therefore, accurate monitoring of urine test parameters in these patients is recommended for the rapid diagnosis of any complications arising from the disease.

Ethical Considerations

Compliance with ethical guidelines
This study was approved by the Ethics Committee of Shahroud University of Medical Sciences, (code: IR.SHMU.REC.1400.007).

Funding
This study was extracted from a master’s thesis in Critical Care Nursing, funded by  Shahroud University of Medical Sciences.

Authors' contributions
Design: Nafiseh Amerion, Hossein Bagheri, and Hossein Ebrahimi; data collection: Nafiseh Amerion, Hossein Bagheri, and Shahrbanou Goli; data analysis: Nafiseh Ameriun and Shahrbanou Goli; editing and review: All authors.

Conflict of interest
The authors declare no Conflict of interest.

Acknowledgments
The authors would like to thank the  Shahroud University of Medical Sciences for the financial support and all managers personnel of Imam Hossein Hospital in Shahroud City for their cooperation.



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Type of Study: Research | Subject: nursing
Received: 2024/05/12 | Accepted: 2025/03/21 | Published: 2025/03/21
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