AKI during COVID-19 infection: low incidence, high risk of death

  1. Zhixiang Mou
  2. Xu Zhang

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Abstract

Background

Coronavirus disease 2019 (COVID-19) has spread rapidly worldwide and seriously threatens human health since December 2019. However, information about acute kidney injury (AKI) during COVID-19 infection is limited. Some studies thought that presence of AKI is very common and cannot be ignored, while some studies pointed that AKI only is a rare incident during COVID-19 infection. This meta-analysis aimed to find out the truth of COVID-19 related AKI and to provide stronger evidence.

Methods

Two authors independently performed a literature search using PubMed, Web of Science, Embase, and Cochrane Library fulfilled the pre-specified criteria until April 25, 2020 to include studies reported the necessary clinic characteristics, then the incidence of AKI, incidence of required RRT, the mortality with AKI and the death risk with AKI during COVID-19 infection were pooled for statistical analysis by Open Meta-Analyst software to get conclusions.

Findings

It was found that the incidence of AKI in hospitalized patients with COVID-19 infection is low, only about 3.8%; the in-hospital mortality with AKI in COVID-19 infected patients is reach up to 32.6%; the death risk with AKI in COVID-19 infected patients is about 16.1 times higher than those without AKI.

Conclusions

This meta-analysis indicated AKI during COVID-19 infection should be pay more attention, it maybe a strong red flag to death risk. It is still need additional studies to support the conclusions and to explore the AKI mechanism during COVID-19 infection.

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  1. Version published to 10.1101/2020.04.29.20079038v3 on medRxiv
  2. ScreenIT

    SciScore for 10.1101/2020.04.29.20079038: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    A systematic literature search was performed using PubMed, Web of Science, Embase, and Cochrane Library from March 01 to May 04, 2020 (inclusive) to summarize the data of AKI on COVID-19 infected patients.
    PubMed
    suggested: (PubMed, RRID:SCR_004846)
    Embase
    suggested: (EMBASE, RRID:SCR_001650)
    Cochrane Library
    suggested: (Cochrane Library, RRID:SCR_013000)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    The present study provides a much-needed evidential basis for AKI incidence among COVID-19 patients, but has several limitations. First, there remains a limited amount of original studies (< 10) by which to evaluate the risk of death with AKI during COVID-19 infection. Nonetheless, considering the potential of this research in advancing our understanding of COVID-19 and in supplying medical practitioners with evidence-based recommendations, and in light of the current global pandemic emergency, the authors took the decision to present these findings forthwith. Second, there is a statistically significant heterogeneity in the meta-analysis for AKI incidence. Potential origins for significant heterogeneity may come from different COVID-19 infection stages. As performed via subgroup analysis according to AKI definitions, the results still reveal a significant heterogeneity. Future heterogeneity exploration must rely on the acquisition of more original clinical data. Finally, since the clinical data collection is based upon publications with limited availability, extra investigations could not be made but should be considered (infection duration, drugs used, geography, ethnicity, and age group in particular). Nevertheless, AKI incidence with COVID-19 infections must demand greater attention. Further studies are still urgently needed to support the conclusion herein and explore the AKI mechanism within a COVID-19 infection context. Although the chance of AKI during COVID-19 is rar...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.04.29.20079038v2 on medRxiv
  4. Version published to 10.1101/2020.04.29.20079038v1 on medRxiv