The Association of Acute Kidney Injury With Disease Severity and Mortality in COVID-19: A Systematic Review and Meta-Analysis

Background and objective The coronavirus disease 2019 (COVID-19) pandemic has become a global healthcare emergency The severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2), the causative agent of COVID-19, has a wide range of clinical manifestations ranging from subclinical infection to multi-organ failure In addition to the respiratory system, COVID-19 also adversely affects the kidneys In this study, we aimed to measure the prevalence of acute kidney injury (AKI) in COVID-19 and its association with the disease severity and mortality in COVID-19 patients Materials and methods We conducted our study by following the Preferred Reporting Items for Systematic Review and Metaanalyses (PRISMA) guidelines A comprehensive literature search using four databases (PubMed, EMBASE, Google Scholar, and clinicaltrial gov) was performed Our initial search returned 2,771 articles After excluding review articles, duplicates, and non-relevant studies, we included 20 articles that reported an association between COVID-19 and AKI We subsequently performed a random effect analysis to find the pooled prevalence, pooled odds ratio (OR) estimates, and 95% confidence intervals for severe COVID-19 and mortality outcomes in AKI using Cochrane RevMan (version 5 4) and R programming language (version 4 16-2) Results A total of 14,415 patients from various countries were included Among the 20 cohorts, the median age was 55 8 +/- 8 39 years (range: 43-72 years), and 43 78% of the subjects were female Out of a total of 14,415 patients, 3,820 developed AKI with a pooled prevalence of 11% (95% CI: 0 07- 0 15;p<0 01;I-2=98%) AKI was found to have a significant association with severe COVID-19 disease, with a pooled OR of 8 45 (95% CI: 5 56-12 56;p<0 00001;I-2= 0%) AKI was associated with significantly higher mortality in patients with COVID-19 with an OR of 13 52 (95% CI: 5 43-33 67;p<0 00001;I-2=88%) Conclusion AKI manifests as a common COVID-19 complication, and COVID-19 patients with AKI generally have poor outcomes in terms of disease severity and mortality