Acute kidney injury in patients with COVID-19 compared to those with influenza: a systematic review and meta-analysis

Chiu-Ying Hsiao; Heng-Chih Pan; Vin-Cent Wu; Ching-Chun Su; Tzu-Hsuan Yeh; Min-Hsiang Chuang; Kuan-Chieh Tu; Hsien-Yi Wang; Wei-Chih Kan; Chun-Chi Yang; Jui-Yi Chen

doi:10.3389/fmed.2023.1252990

Acute kidney injury in patients with COVID-19 compared to those with influenza: a systematic review and meta-analysis

Front Med (Lausanne). 2023 Sep 19:10:1252990. doi: 10.3389/fmed.2023.1252990. eCollection 2023.

Authors

Chiu-Ying Hsiao¹, Heng-Chih Pan^{2

3

4

5}, Vin-Cent Wu⁶, Ching-Chun Su¹, Tzu-Hsuan Yeh¹, Min-Hsiang Chuang¹, Kuan-Chieh Tu⁷, Hsien-Yi Wang^{1

8}, Wei-Chih Kan^{1

9}, Chun-Chi Yang¹⁰, Jui-Yi Chen^{11

8}

Affiliations

¹ Division of Nephrology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan.
² Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
³ Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelungi, Taiwan.
⁴ Chang Gung University College of Medicine, Taoyuan, Taiwan.
⁵ Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.
⁶ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
⁷ Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
⁸ Department of Sport Management, College of Leisure and Recreation Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
⁹ Department of Medical Laboratory Science and Biotechnology, Chung Hwa University of Medical Technology, Tainan, Taiwan.
¹⁰ Division of Hepato-gastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
¹¹ Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.

Abstract

Background: COVID-19 and influenza can both lead to acute kidney injury (AKI) as a common complication. However, no meta-analysis has been conducted to directly compare the incidence of AKI between hospitalized patients with COVID-19 and influenza. The objective of our study aims to investigate the incidence and outcomes of AKI among hospitalized patients between these two groups.

Materials and methods: A systematic search of PubMed, Embase, and Cochrane databases was conducted from December 2019 to August 2023 to identify studies examining AKI and clinical outcomes among hospitalized patients with COVID-19 and influenza. The primary outcome of interest was the incidence of AKI, while secondary outcomes included in-hospital mortality, recovery from AKI, hospital and ICU stay duration. The quality of evidence was evaluated using Cochrane and GRADE methods.

Results: Twelve retrospective cohort studies, involving 17,618 hospitalized patients with COVID-19 and influenza, were analyzed. COVID-19 patients showed higher AKI incidence (29.37% vs. 20.98%, OR: 1.67, 95% CI 1.56-1.80, p < 0.01, I² = 92.42%), and in-hospital mortality (30.95% vs. 5.51%, OR: 8.16, 95% CI 6.17-10.80, p < 0.01, I² = 84.92%) compared to influenza patients with AKI. Recovery from AKI was lower in COVID-19 patients (57.02% vs., 80.23%, OR: 0.33, 95% CI 0.27-0.40, p < 0.01, I² = 85.17%). COVID-19 patients also had a longer hospital stay (SMD: 0.69, 95% CI 0.65-0.72, p < 0.01, I² = 98.94%) and longer ICU stay (SMD: 0.61, 95% CI 0.50-0.73, p < 0.01, I² = 94.80%) than influenza patients. In our study, evidence quality was high (NOS score 7-9), with low certainty for AKI incidence and moderate certainty for recovery form AKI by GRADE assessment.

Conclusion: COVID-19 patients had higher risk of developing AKI, experiencing in-hospital mortality, and enduring prolonged hospital/ICU stays in comparison to influenza patients. Additionally, the likelihood of AKI recovery was lower among COVID-19 patients.

Keywords: COVID-19; acute kidney injury; influenza; mortality; recovery.

Publication types

Systematic Review