key: cord-0815222-2boqg3tz
authors: Wang, Ying; Shi, Li; Yang, Haiyan; Duan, Guangcai; Wang, Yadong
title: Acute kidney injury is associated with the mortality of coronavirus disease 2019
date: 2020-05-25
journal: J Med Virol
DOI: 10.1002/jmv.26019
sha: 04fb3c5f319282f82f1e150db96d9d71dcfd3f05
doc_id: 815222
cord_uid: 2boqg3tz

We read with great interest the recent article "Analysis of 92 deceased patients with COVID-19" by Yang et al. published in the Journal of medical virology. The authors observed that 14 patients suffered renal injury after infection of SARS-CoV-2 in 92 deceased patients with coronavirus disease 2019 (COVID-19), although none of them had chronic renal insufficiency. This article is protected by copyright. All rights reserved.

Studies have shown that the kidneys may be at high risk for viral invasion. 2 However, some studies are indicating that there might not be an association between acute kidney injury (AKI) and the risk of mortality in patients with COVID-19. 3, 4 Thus, the association of AKI with the risk of mortality in patients with COVID-19 is still inconclusive. Moreover, the incidence of AKI has been reported to vary among different clinical centers. 5, 6 To obtain a definite conclusion on the association between AKI and the risk of mortality in patients with COVID-19, a meta-analysis was performed, which may provide an evidence-based medicine proof for clinicians in the management of COVID-19 patients with AKI.

We selected relevant studies published until 26 April 2020, by searching PubMed, Web of Science, and China National Knowledge Infrastructure, using the searching terms: "coronavirus" or "COVID-19"

or "SARS-CoV-2" or "2019-nCoV" and "laboratory" or "clinical" and "mortality" or "outcome". Articles reporting in patients with COVID-19 on AKI and creatinine for both non-survival and survival patients were included. The combined effects were estimated as odds ratio (OR) along with its 95% confidence interval (CI) for AKI. The weighted mean difference (WMD) and 95% CI were calculated for the combined effects of creatinine. Subgroup analysis of the creatinine levels of the patients was Table S1 . The basic characteristics of AKI are shown in Table S2 . There were 11 studies with a total of 7437 patients including 573 (34.0%) patients with AKI and 532 (9.3%) without AKI in non-survivors (Table S3 ). This metaanalysis showed that AKI was associated with a higher risk of mortality in COVID-19 patients (OR = 15.93, 95% CI: 7.69-32.98, P < .001; I 2 = 78.1%, P < .001) ( Figure 1A) . None of these factors (such as sample size, AKI definition, and location) could explain the significant heterogeneity by meta-regression and subgroup analysis (Table S4 ). In addition, sensitivity analysis indicated that the combined OR did not change significantly when a single study was removed one by one, indicating that our results were reliable and robust ( Figure 1B) . No publication bias was found (Egger's test P = .266; Begg's test P = .436).

The level of creatinine elevation is related to the severity of AKI 9 and the serum creatinine level is used as a criterion for AKI. 10 Table S5 ). This observation supported the notion that AKI was associated with the risk of mortality in patients with COVID-19 in the other aspect to a certain extent.

In summary, our findings demonstrated that AKI was associated with the mortality in patients with COVID-19, which can be a predictor for poor outcomes in patients with COVID-19. Hence, clinicians should increase their awareness of AKI in patients with COVID-19. However, there are also some limitations to our metaanalysis. First, the meta-analysis result of AKI with mortality in patients with COVID-19 had high heterogeneity. Second, the included studies for this present meta-analysis failed to describe comorbidity characteristics of individual patients, and it was hard to adjust for confounding factors at present. Further analyses including more studies are needed to verify our findings.

Analysis of 92 deceased patients with COVID-19

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Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China

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Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range

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Kidney disease improving global outcomes or creatinine kinetics criteria in acute kidney injury: a proof of concept study