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肾脏疾病与 COVID-19 疾病严重程度:系统评价和荟萃分析。

Kidney disease and COVID-19 disease severity-systematic review and meta-analysis.

机构信息

Geisinger Commonwealth School of Medicine, Scranton, PA, USA.

Department of Public Health, Icahn School of Medicine At Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, USA.

出版信息

Clin Exp Med. 2022 Feb;22(1):125-135. doi: 10.1007/s10238-021-00715-x. Epub 2021 Apr 23.


DOI:10.1007/s10238-021-00715-x
PMID:33891214
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8063780/
Abstract

We aimed to identify prevalence and association of comorbid chronic kidney disease (CKD), acute kidney injury (AKI) and utilization prevalence of continuous renal replacement therapy (CRRT) in COVID-19-hospitalized patients as a function of severity status. With the ongoing struggle across the globe to combat COVID-19 disease, published literature has described the role of kidney disease in COVID-19 patients based on single/multicenter experiences across the globe. We extracted data from observational studies describing comorbid CKD, AKI and CRRT and outcomes and severity of COVID-19-hospitalized patients from December 1, 2019-August 20, 2020 following PRISMA guidelines. Severity of COVID-19 includes intensive care unit admission, oxygen saturation < 90%, invasive mechanical ventilation utilization, in-hospital admission and mortality. Meta-analysis was performed using a random-effects model to calculate pooled estimates, and forest plots were created. In total, 29 studies with 15,017 confirmed COVID-19 patients were included. The overall prevalence of AKI was 11.6% [(430/3693)], comorbid CKD 9.7% [(1342/13,728)] and CRRT 2.58% [(102/3946)] in our meta-analysis. We also found higher odds of comorbid CKD (pooled OR: 1.70; 95%CI: 1.21-2.40; p = 0.002), AKI (8.28; 4.42-15.52; p < 0.00001) and utilization of CRRT (16.90; 9.00-31.74; p < 0.00001) in patients with severe COVID-19 disease. Conclusion Our meta-analysis suggests that comorbid CKD, AKI and utilization of CRRT were significantly associated with COVID-19 disease severity. Clinicians should focus on early triaging of COVID-19 patients with comorbid CKD and at risk for AKI to prevent complication and mortality.

摘要

我们旨在确定 COVID-19 住院患者中合并存在的慢性肾脏病 (CKD)、急性肾损伤 (AKI) 和连续性肾脏替代治疗 (CRRT) 的患病率及其与疾病严重程度的关联。在全球范围内持续努力抗击 COVID-19 疾病的过程中,已发表的文献基于全球范围内的单中心或多中心经验,描述了肾脏疾病在 COVID-19 患者中的作用。我们按照 PRISMA 指南,从 2019 年 12 月 1 日至 2020 年 8 月 20 日期间,提取了描述 COVID-19 住院患者合并存在 CKD、AKI 和 CRRT 以及疾病严重程度的观察性研究的数据。COVID-19 严重程度包括入住重症监护病房、氧饱和度 < 90%、使用有创机械通气、住院和死亡。采用随机效应模型进行荟萃分析,以计算汇总估计值,并绘制森林图。共有 29 项研究纳入了 15017 例确诊的 COVID-19 患者。我们的荟萃分析中,AKI 的总体患病率为 11.6%(430/3693),合并 CKD 的患病率为 9.7%(1342/13728),CRRT 的患病率为 2.58%(102/3946)。我们还发现,合并存在 CKD 的患者发生 AKI 的可能性更高(汇总 OR:1.70;95%CI:1.21-2.40;p = 0.002)、发生 AKI 的可能性更高(汇总 OR:8.28;4.42-15.52;p < 0.00001)和使用 CRRT 的可能性更高(汇总 OR:16.90;9.00-31.74;p < 0.00001),提示这些患者的 COVID-19 疾病更严重。结论我们的荟萃分析表明,合并存在 CKD、AKI 和使用 CRRT 与 COVID-19 疾病严重程度显著相关。临床医生应重点关注合并存在 CKD 和有发生 AKI 风险的 COVID-19 患者的早期分诊,以预防并发症和死亡。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a494/8063780/7c5aa6f2d831/10238_2021_715_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a494/8063780/7a62cf7860fc/10238_2021_715_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a494/8063780/6ad51b771e60/10238_2021_715_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a494/8063780/242c248032ed/10238_2021_715_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a494/8063780/7c5aa6f2d831/10238_2021_715_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a494/8063780/7a62cf7860fc/10238_2021_715_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a494/8063780/6ad51b771e60/10238_2021_715_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a494/8063780/242c248032ed/10238_2021_715_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a494/8063780/7c5aa6f2d831/10238_2021_715_Fig4_HTML.jpg

相似文献

[1]
Kidney disease and COVID-19 disease severity-systematic review and meta-analysis.

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[2]
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[3]
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[4]
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[7]
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[8]
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[1]
Prevalence of comorbidities and their association with disease severity and mortality in COVID-19 patients: A systematic review and meta-analysis.

J Multimorb Comorb. 2025-8-28

[2]
Imaging and Laboratory Results as Predictors of the Course of COVID-19.

Adv Respir Med. 2025-7-1

[3]
Impact of Prior Chronic Kidney Disease and Newly Detected eGFR Impairment at Admission on Outcomes and Prognosis of Hospitalized COVID-19 Patients - A Single-Center Cohort Study.

Int J Gen Med. 2025-2-5

[4]
Multisystem inflammatory syndrome in adults hospitalizations in the United States; evaluating patient characteristics, COVID-19 associations, and mortality.

Arch Med Sci Atheroscler Dis. 2024-9-16

[5]
The association of micro and macro worries with psychological distress in people living with chronic kidney disease during the COVID-19 pandemic.

PLoS One. 2024

[6]
COVID-19 Vaccination Recommendations for Immunocompromised Patient Populations: Delphi Panel and Consensus Statement Generation in the United States.

Infect Dis Ther. 2024-11

[7]
The evolution of public attention in acute kidney injury and continuous renal replacement therapy: trends analysis from 2004 to 2024.

Front Nephrol. 2024-9-18

[8]
Pre-Existing Atrial Fibrillation in Hospitalized Patients with COVID-19: Insights from the CARDIO COVID 19-20 Registry.

J Cardiovasc Dev Dis. 2024-7-4

[9]
Prognostic significance of chronic kidney disease and impaired renal function in Japanese patients with COVID-19.

BMC Infect Dis. 2024-5-25

[10]
Variation in Time Between Testing Positive for COVID-19 and Hospital Admission by Race/Ethnicity and Insurance Status.

J Health Care Poor Underserved. 2023

本文引用的文献

[1]
The Involvement of Chronic Kidney Disease and Acute Kidney Injury in Disease Severity and Mortality in Patients with COVID-19: A Meta-Analysis.

Kidney Blood Press Res. 2021

[2]
Characteristics and outcomes of COVID-19 patients in New York City's public hospital system.

PLoS One. 2020-12-17

[3]
COVID-19-associated acute kidney injury: consensus report of the 25th Acute Disease Quality Initiative (ADQI) Workgroup.

Nat Rev Nephrol. 2020-10-15

[4]
The Association Between Chronic Kidney Disease and New Onset Renal Replacement Therapy on the Outcome of COVID-19 Patients: A Meta-analysis.

Clin Med Insights Circ Respir Pulm Med. 2020-9-17

[5]
Characteristics and Outcomes of Individuals With Pre-existing Kidney Disease and COVID-19 Admitted to Intensive Care Units in the United States.

Am J Kidney Dis. 2021-2

[6]
COVID-19 and the Kidneys: An Update.

Front Med (Lausanne). 2020-7-21

[7]
Outcomes for Patients With COVID-19 and Acute Kidney Injury: A Systematic Review and Meta-Analysis.

Kidney Int Rep. 2020-6-25

[8]
Acute kidney injury is associated with severe infection and fatality in patients with COVID-19: A systematic review and meta-analysis of 40 studies and 24,527 patients.

Pharmacol Res. 2020-7-31

[9]
Kidney Replacement Therapy in COVID-19 Induced Kidney Failure and Septic Shock: A Pediatric Continuous Renal Replacement Therapy [PCRRT] Position on Emergency Preparedness With Resource Allocation.

Front Pediatr. 2020-7-3

[10]
Frequency of Continuous Renal Replacement Therapy Use Early in Coronavirus Disease 2019 Pandemic.

Crit Care Explor. 2020-5-14

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