简介:在人群水平上,基础非传染性疾病对急性肾损伤(AKI)发病率的定量影响以及影响2019年冠状病毒病(COVID-19)AKI患者死亡几率的因素尚不清楚。本研究旨在评估AKI之间的关联,死亡率,潜在的非传染性疾病,和临床危险因素。方法:从2020年1月1日至2020年10月5日,对六个数据库进行了系统搜索。纳入了同行评审的观察性研究,其中包含有关COVID-19危险因素和肾脏表现发生率的定量数据。位置,机构,和时间段进行了匹配,以避免重复的数据源。发病率,患病率,通过随机效应荟萃分析提取和汇总结局的比值比.对肾脏替代治疗(RRT)史和年龄组进行分层分析。使用AKI发生率作为因变量建立单变量元回归模型,以潜在的合并症和入院时的临床表现为独立变量。结果:COVID-19患者AKI和RRT的总体发生率分别为20.40%[95%置信区间(CI)=12.07-28.74]和2.97%(95%CI=1.91-4.04),分别,在没有RRT病史的患者中。住院期间发生AKI的患者死亡或危重几率增加8倍(合并OR=9.03,95%CI=5.45-14.94)和16.6倍(合并OR=17.58,95%CI=10.51-29.38)。在人口层面,基础糖尿病患病率的每一个百分比增加,高血压,慢性肾病,肿瘤病史与0.82%相关(95%CI=0.40-1.24),0.48%(95%CI=0.18-0.78),0.99%(95%CI=0.18-1.79),2.85%(95%CI=0.93-4.76)的AKI发病率在不同的环境中增加,分别。尽管接受肾脏移植的患者AKI和RRT的发生率较高,他们的死亡率较低。观察到AKI患者的死亡几率相对于症状发作和入院之间的间隔增加的积极趋势。结论:非传染性疾病的潜在患病率部分解释了人群水平AKI发病率的异质性。症状发作后延迟入院可能与发生AKI的患者死亡率较高有关,值得进一步研究。
Introduction: The quantitative effect of underlying non-communicable diseases on acute kidney injury (AKI) incidence and the factors affecting the odds of death among coronavirus disease 2019 (COVID-19) AKI patients were unclear at population level. This study aimed to assess the association between AKI, mortality, underlying non-communicable diseases, and clinical risk factors. Methods: A systematic search of six databases was performed from January 1, 2020, until October 5, 2020. Peer-reviewed observational studies containing quantitative data on risk factors and incidence of renal manifestations of COVID-19 were included. Location, institution, and time period were matched to avoid duplicated data source. Incidence, prevalence, and odds ratio of outcomes were extracted and pooled by random-effects meta-analysis. History of renal replacement therapy (RRT) and age group were stratified for analysis. Univariable meta-regression models were built using AKI incidence as dependent variable, with underlying comorbidities and clinical presentations at admission as independent variables. Results: Global incidence rates of AKI and RRT in COVID-19 patients were 20.40% [95% confidence interval (CI) = 12.07-28.74] and 2.97% (95% CI = 1.91-4.04), respectively, among patients without RRT history. Patients who developed AKI during hospitalization were associated with 8 times (pooled OR = 9.03, 95% CI = 5.45-14.94) and 16.6 times (pooled OR = 17.58, 95% CI = 10.51-29.38) increased odds of death or being critical. At population level, each percentage increase in the underlying prevalence of diabetes, hypertension, chronic kidney disease, and tumor history was associated with 0.82% (95% CI = 0.40-1.24), 0.48% (95% CI = 0.18-0.78), 0.99% (95% CI = 0.18-1.79), and 2.85% (95% CI = 0.93-4.76) increased incidence of AKI across different settings, respectively. Although patients who had a kidney transplant presented with a higher incidence of AKI and RRT, their odds of mortality was lower. A positive trend of increased odds of death among AKI patients against the interval between symptom onset and hospital admission was observed. Conclusion: Underlying prevalence of non-communicable diseases partly explained the heterogeneity in the AKI incidence at population level. Delay in admission after symptom onset could be associated with higher mortality among patients who developed AKI and warrants further research.