Department of Internal Medicine, UPMC Pinnacle Harrisburg, Harrisburg, Pennsylvania, USA
Department of Internal Medicine, UPMC Pinnacle Harrisburg, Harrisburg, Pennsylvania, USA.
J Investig Med. 2020 Oct;68(7):1261-1270. doi: 10.1136/jim-2020-001407. Epub 2020 Jul 12.
Acute kidney injury (AKI) is a complication of COVID-19. However, the incidence of AKI in COVID-19 varies among studies. Thus, we aimed to evaluate the pooled incidence of AKI and its association with mortality in patients with COVID-19 using a meta-analysis. We search Ovid MEDLINE, EMBASE, and the Cochrane Library for eligible publications reporting the clinical characteristics of patients with COVID-19 without language restriction. Incidence of AKI and mortality were reported. Meta-regression was used to describe the association between outcomes. From 26 studies (n=5497), the pooled incidence of AKI in patients with COVID-19 was 8.4% (95% CI 6.0% to 11.7%) with a pooled incidence of renal replacement therapy of 3.6% (95% CI 1.8% to 7.1%). The incidence of AKI was higher in critically ill patients (19.9%) compared with hospitalized patients (7.3%). The pooled estimated odds ratio for mortality from AKI was 13.33 (95% CI 4.05 to 43.91). No potential publication bias was detected. By using meta-regression analyses, the incidence of AKI was positively associated with mortality after adjusted for age and sex (Q=26.18; p=0.02). Moreover, age (p<0.01), diabetes (p=0.02), hypertension (p<0.01) and baseline serum creatinine levels (p=0.04) were positively associated with AKI incidence in adjusted models. In conclusion, AKI is present in 8.3% of overall patients with COVID-19 and in 19.9% of critically ill patients with COVID-19. Presence of AKI is associated with 13-fold increased risk of mortality. Age, diabetes, hypertension, and baseline serum creatinine levels are associated with increased AKI incidence.
急性肾损伤（AKI）是 COVID-19 的一种并发症。然而，COVID-19 患者中 AKI 的发生率在不同的研究中有所不同。因此，我们旨在通过荟萃分析评估 COVID-19 患者 AKI 的发生率及其与死亡率的关系。我们检索了 Ovid MEDLINE、EMBASE 和 Cochrane 图书馆，以查找报告无语言限制的 COVID-19 患者临床特征的合格出版物。报告了 AKI 的发生率和死亡率。使用元回归来描述结局之间的关联。从 26 项研究（n=5497）中，COVID-19 患者 AKI 的总发生率为 8.4%（95%CI 6.0%至 11.7%），接受肾脏替代治疗的总发生率为 3.6%（95%CI 1.8%至 7.1%）。危重症患者 AKI 的发生率（19.9%）高于住院患者（7.3%）。AKI 导致死亡率的估计比值比为 13.33（95%CI 4.05 至 43.91）。未检测到潜在的发表偏倚。通过使用元回归分析，在调整年龄和性别后，AKI 的发生率与死亡率呈正相关（Q=26.18；p=0.02）。此外，在调整模型中，年龄（p<0.01）、糖尿病（p=0.02）、高血压（p<0.01）和基线血清肌酐水平（p=0.04）与 AKI 发生率呈正相关。总之，8.3%的 COVID-19 患者和 19.9%的危重症 COVID-19 患者存在 AKI。AKI 的存在与死亡率增加 13 倍相关。年龄、糖尿病、高血压和基线血清肌酐水平与 AKI 发生率增加相关。
