The Prevalence of Acute Kidney Injury in Patients Hospitalized With COVID-19 Infection: A Systematic Review and Meta-analysis.
The Prevalence of Acute Kidney Injury in Patients Hospitalized With COVID-19 Infection: A Systematic Review and Meta-analysis.
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DOI：
10.1016/j.xkme.2020.11.008
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发表时间：
2021-01
期刊：
影响因子：
3.9
通讯作者：
Harel Z
中科院分区：
文献类型：
--
作者：
Silver SA;Beaubien-Souligny W;Shah PS;Harel S;Blum D;Kishibe T;Meraz-Munoz A;Wald R;Harel Z
2019 年冠状病毒病 (COVID-19) 可能与急性肾损伤 (AKI) 和肾脏替代治疗 (KRT) 的高发生率有关，可能会导致医疗保健资源不堪重负。我们的目标是确定住院的 COVID-19 患者中 AKI 和 KRT 的汇总患病率。系统回顾和荟萃分析。 MEDLINE、Embase、Cochrane 图书馆和预印本研究登记册，截至 2020 年 10 月 14 日发布。符合条件的研究根据肾脏疾病：改善全球结果 (KDIGO) 的定义报告了住院的 COVID-19 患者中 AKI 的患病率。我们提取了有关患者特征、发生 AKI 并开始 KRT 的患者比例、重要临床结果（出院、持续住院和死亡）以及偏倚风险的数据。我们使用随机效应模型计算了 AKI 和 KRT 接受情况的汇总患病率以及 95% CI。我们根据入住重症监护病房 (ICU) 的情况进行了亚组分析。在审查的 2,711 条记录中，我们纳入了 53 项已发表研究和 1 项预印本研究，其中包括 30,657 名住院的 COVID-19 患者。 30,639 名患者（n = 54 项研究）的 AKI 数据可用，27,525 名患者（n = 48 项研究）接受 KRT 的数据可用。 AKI 的汇总患病率为 28%（95% CI，22%-34%；I2 = 99%），KRT 的汇总患病率为 9%（95% CI，7%-11%；I2 = 97%）。入住 ICU 的患者中 AKI 的汇总患病率为 46%（95% CI，35%-57%；I2 = 99%），所有 ICU 感染 COVID-19 的患者中有 19%（95% CI，15%-22%；I2 = 88%）开始 KRT。纳入的研究之间存在显着的异质性，这些异质性在亚组分析中仍未得到解释。近三分之一的 COVID-19 住院患者中，AKI 导致病程复杂化。重症患者发生 AKI 的风险较高，其中相当多的患者接受 KRT 的比例高于一般 ICU 人群。由于 COVID-19 在可预见的未来将成为公共卫生威胁，因此这些估计应有助于指导 KRT 资源规划。
Coronavirus disease 2019 (COVID-19) may be associated with high rates of acute kidney injury (AKI) and kidney replacement therapy (KRT), potentially overwhelming health care resources. Our objective was to determine the pooled prevalence of AKI and KRT among hospitalized patients with COVID-19. Systematic review and meta-analysis. MEDLINE, Embase, the Cochrane Library, and a registry of preprinted studies, published up to October 14, 2020. Eligible studies reported the prevalence of AKI in hospitalized patients with COVID-19 according to the Kidney Disease: Improving Global Outcomes (KDIGO) definition. We extracted data on patient characteristics, the proportion of patients developing AKI and commencing KRT, important clinical outcomes (discharge from hospital, ongoing hospitalization, and death), and risk of bias. We calculated the pooled prevalence of AKI and receipt of KRT along with 95% CIs using a random-effects model. We performed subgroup analysis based on admission to an intensive care unit (ICU). Of 2,711 records reviewed, we included 53 published and 1 preprint study in the analysis, which comprised 30,657 hospitalized patients with COVID-19. Data for AKI were available for 30,639 patients (n = 54 studies), and receipt of KRT, for 27,525 patients (n = 48 studies). The pooled prevalence of AKI was 28% (95% CI, 22%-34%; I2 = 99%), and the pooled prevalence of KRT was 9% (95% CI, 7%-11%; I2 = 97%). The pooled prevalence of AKI among patients admitted to the ICU was 46% (95% CI, 35%-57%; I2 = 99%), and 19% of all ICU patients with COVID-19 (95% CI, 15%-22%; I2 = 88%) commenced KRT. There was significant heterogeneity among the included studies, which remained unaccounted for in subgroup analysis. AKI complicated the course of nearly 1 in 3 patients hospitalized with COVID-19. The risk for AKI was higher in critically ill patients, with a substantial number receiving KRT at rates higher than the general ICU population. Because COVID-19 will be a public health threat for the foreseeable future, these estimates should help guide KRT resource planning.
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