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2020 ; 7
(ä): 2054358120938573
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Multiorgan Failure With Emphasis on Acute Kidney Injury and Severity of COVID-19:
Systematic Review and Meta-Analysis
#MMPMID32685180
Lim MA
; Pranata R
; Huang I
; Yonas E
; Soeroto AY
; Supriyadi R
Can J Kidney Health Dis
2020[]; 7
(ä): 2054358120938573
PMID32685180
show ga
BACKGROUND: Abnormalities in hematologic, biochemical, and immunologic biomarkers
have been shown to be associated with severity and mortality in Coronavirus
Disease 2019 (COVID-19). Therefore, early evaluation and monitoring of both liver
and kidney functions, as well as hematologic parameters, are pivotal to forecast
the progression of COVID-19. OBJECTIVES: In this study, we performed a systematic
review and meta-analysis to investigate the association between several
complications, including acute kidney injury (AKI), acute liver injury (ALI), and
coagulopathy, with poor outcomes in COVID-19. DESIGN: Systematic review and
meta-analysis. SETTING: Observational studies reporting AKI, ALI, and
coagulopathy along with the outcomes of clinically validated death, severe
COVID-19, or intensive care unit (ICU) care were included in this study. The
exclusion criteria were abstract-only publications, review articles,
commentaries, letters, case reports, non-English language articles, and studies
that did not report key exposures or outcomes of interest. PATIENTS: Adult
patients diagnosed with COVID-19. MEASUREMENTS: Data extracted included author,
year, study design, age, sex, cardiovascular diseases, hypertension, diabetes
mellitus, respiratory comorbidities, chronic kidney disease, mortality, severe
COVID-19, and need for ICU care. METHODS: We performed a systematic literature
search from PubMed, SCOPUS, EuropePMC, and the Cochrane Central Database. AKI and
ALI follow the definition of the included studies. Coagulopathy refers to the
coagulopathy or disseminated intravascular coagulation defined in the included
studies. The outcome of interest was a composite of mortality, need for ICU care,
and severe COVID-19. We used random-effects models regardless of heterogeneity to
calculate risk ratios (RRs) for dichotomous variables. Heterogeneity was assessed
using I (2). Random effects meta-regression was conducted for comorbidities and
the analysis was performed for one covariate at a time. RESULTS: There were 3615
patients from 15 studies. The mean Newcastle-Ottawa scale of the included studies
was 7.3 ± 1.2. The AKI was associated with an increased the composite outcome
(RR: 10.55 [7.68, 14.50], P < .001; I (2): 0%). Subgroup analysis showed that AKI
was associated with increased mortality (RR: 13.38 [8.15, 21.95], P < .001; I
(2): 24%), severe COVID-19 (RR: 8.12 [4.43, 14.86], P < .001; I (2): 0%), and the
need for ICU care (RR: 5.90 [1.32, 26.35], P = .02; I (2): 0%). The ALI was
associated with increased mortality (RR: 4.02 [1.51, 10.68], P = .005; I (2):
88%) in COVID-19. Mortality was higher in COVID-19 with coagulopathy (RR: 7.55
[3.24, 17.59], P < .001; I (2): 69%). The AKI was associated with the composite
outcome and was not influenced by age (P = .182), sex (P = .104), hypertension (P
= .788), cardiovascular diseases (P = .068), diabetes (P = .097), respiratory
comorbidity (P = .762), and chronic kidney disease (P = .77). LIMITATIONS: There
are several limitations of this study. Many of these studies did not define the
extent of AKI (grade), which may affect the outcome. Acute liver injury and
coagulopathy were not defined in most of the studies. The definition of severe
COVID-19 differed across studies. Several articles included in the study were
published at preprint servers and are not yet peer-reviewed. Most of the studies
were from China; thus, some patients might overlap across the reports. Most of
the included studies were retrospective in design. CONCLUSIONS: This
meta-analysis showed that the presence of AKI, ALI, and coagulopathy was
associated with poor outcomes in patients with COVID-19.