新型冠状病毒肺炎患者与流感患者的急性肾损伤：一项系统评价和荟萃分析。
Acute kidney injury in patients with COVID-19 compared to those with influenza: a systematic review and meta-analysis.
作者信息
Hsiao Chiu-Ying, Pan Heng-Chih, Wu Vin-Cent, Su Ching-Chun, Yeh Tzu-Hsuan, Chuang Min-Hsiang, Tu Kuan-Chieh, Wang Hsien-Yi, Kan Wei-Chih, Yang Chun-Chi, Chen Jui-Yi
机构信息
Division of Nephrology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan.
Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
出版信息
Front Med (Lausanne). 2023 Sep 19;10:1252990. doi: 10.3389/fmed.2023.1252990. eCollection 2023.
BACKGROUND
COVID-19 and influenza can both lead to acute kidney injury (AKI) as a common complication. However, no meta-analysis has been conducted to directly compare the incidence of AKI between hospitalized patients with COVID-19 and influenza. The objective of our study aims to investigate the incidence and outcomes of AKI among hospitalized patients between these two groups.
MATERIALS AND METHODS
A systematic search of PubMed, Embase, and Cochrane databases was conducted from December 2019 to August 2023 to identify studies examining AKI and clinical outcomes among hospitalized patients with COVID-19 and influenza. The primary outcome of interest was the incidence of AKI, while secondary outcomes included in-hospital mortality, recovery from AKI, hospital and ICU stay duration. The quality of evidence was evaluated using Cochrane and GRADE methods.
RESULTS
Twelve retrospective cohort studies, involving 17,618 hospitalized patients with COVID-19 and influenza, were analyzed. COVID-19 patients showed higher AKI incidence (29.37% vs. 20.98%, OR: 1.67, 95% CI 1.56-1.80, < 0.01, I = 92.42%), and in-hospital mortality (30.95% vs. 5.51%, OR: 8.16, 95% CI 6.17-10.80, < 0.01, I = 84.92%) compared to influenza patients with AKI. Recovery from AKI was lower in COVID-19 patients (57.02% vs., 80.23%, OR: 0.33, 95% CI 0.27-0.40, < 0.01, I = 85.17%). COVID-19 patients also had a longer hospital stay (SMD: 0.69, 95% CI 0.65-0.72, < 0.01, I = 98.94%) and longer ICU stay (SMD: 0.61, 95% CI 0.50-0.73, < 0.01, I = 94.80%) than influenza patients. In our study, evidence quality was high (NOS score 7-9), with low certainty for AKI incidence and moderate certainty for recovery form AKI by GRADE assessment.
CONCLUSION
COVID-19 patients had higher risk of developing AKI, experiencing in-hospital mortality, and enduring prolonged hospital/ICU stays in comparison to influenza patients. Additionally, the likelihood of AKI recovery was lower among COVID-19 patients.
背景
新型冠状病毒肺炎（COVID-19）和流感均可导致急性肾损伤（AKI）这一常见并发症。然而，尚未进行荟萃分析以直接比较COVID-19住院患者和流感住院患者中AKI的发生率。我们研究的目的旨在调查这两组住院患者中AKI的发生率及转归。
材料与方法
2019年12月至2023年8月对PubMed、Embase和Cochrane数据库进行系统检索，以识别研究COVID-19和流感住院患者中AKI及临床转归的研究。感兴趣的主要结局是AKI的发生率，次要结局包括住院死亡率、AKI恢复情况、住院时间和重症监护病房（ICU）住院时间。使用Cochrane和GRADE方法评估证据质量。
结果
分析了12项回顾性队列研究，涉及17618例COVID-19和流感住院患者。与发生AKI的流感患者相比，COVID-19患者的AKI发生率更高（29.37%对20.98%，比值比[OR]：1.67，95%置信区间[CI]1.56 - 1.80，P < 0.01，I² = 92.42%），住院死亡率更高（30.95%对5.51%，OR：8.16，95% CI 6.17 - 10.80，P < 0.01，I² = 84.92%）。COVID-19患者从AKI恢复的比例更低（57.02%对80.23%，OR：0.33，95% CI 0.27 - 0.40，P < 0.01，I² = 85.17%）。COVID-19患者的住院时间也比流感患者更长（标准化均数差[SMD]：0.69，95% CI 0.65 - 0.72，P < 0.01，I² = 98.94%），ICU住院时间更长（SMD：0.61，95% CI 0.50 - 0.73，P < 0.01，I² = 94.80%）。在我们的研究中，证据质量高（纽卡斯尔 - 渥太华量表[NOS]评分7 - 9），根据GRADE评估，AKI发生率的确定性低，AKI恢复情况的确定性中等。
结论
与流感患者相比，COVID-19患者发生AKI、住院死亡及住院/ICU住院时间延长的风险更高。此外，COVID-19患者AKI恢复的可能性更低。
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