Multiorgan Failure With Emphasis on Acute Kidney Injury and Severity of COVID-19: Systematic Review and Meta-Analysis

• Published in: Canadian journal of kidney health and disease Vol. 7; p. 2054358120938573
• Main Authors: Lim, Michael Anthonius, Pranata, Raymond, Huang, Ian, Yonas, Emir, Soeroto, Arto Yuwono, Supriyadi, Rudi
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-01-2020; SAGE Publishing
• Subjects: Original Clinical Research Quantitative; COVID-19; acute kidney injury; coagulopathy; acute liver injury; multiorgan dysfunction
• ISSN: 2054-3581; 2054-3581
• DOI: 10.1177/2054358120938573

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 I2. 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;
I2: 0%). Subgroup analysis showed that AKI was associated
with increased mortality (RR: 13.38 [8.15, 21.95], P < .001;
I2: 24%), severe COVID-19 (RR: 8.12 [4.43, 14.86],
P < .001; I2: 0%), and the need for
ICU care (RR: 5.90 [1.32, 26.35], P = .02;
I2: 0%). The ALI was associated with increased mortality
(RR: 4.02 [1.51, 10.68], P = .005; I2: 88%)
in COVID-19. Mortality was higher in COVID-19 with coagulopathy (RR: 7.55 [3.24, 17.59],
P < .001; I2: 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.