慢性肾脏疾病与COVID-19预后关系的meta分析

Meta analysis of relationship between chronic kidney disease and COVID-19 prognosis

目的系统评价慢性肾脏疾病(CKD)与新型冠状病毒肺炎(COVID-19)预后的关系及新型冠状病毒(SARS-CoV-2)感染对肾脏的损伤程度。方法计算机检索Cochrane Library、PubMed、Medline、medRxiv、中国知网关于SARS-CoV-2感染及CKD与COVID-19患者预后关系的回顾性研究,文献日期为2020年1月至2021至3月。以OR、WMD及95%CI为效应量衡量CKD与SARS-CoV-2感染的关联程度。由两名研究人员独立提取数据并行文献质量评价后,对所纳入的病例行meta分析。结果共纳入57篇相关文献,总计41235例患者。与非CKD患者比较,CKD患者在感染SARS-CoV-2后更易进展至危重症阶段(OR=3.36)或死亡(OR=3.75),CKD总体人群预后不良(OR=3.43)。与COVID-19轻症患者比较,COVID-19重症患者更易发生急性肾损伤(AKI,OR=11.31);而肌酐(WMD=3.70)与尿酸值(WMD=1.42)在重症患者中也明显高于普通患者(P<0.01)。结论CKD患者在感染SARS-CoV-2后更易发展至为危重症阶段或死亡,同时感染SARS-CoV-2也更易引起AKI和肌酐、尿酸水平升高。

Objective To evaluate the relationship between chronic kidney disease(CKD)and the prognosis of novel coronavirus pneumonia(COVID-19)and the damage degree of novel coronavirus(SARS-CoV-2)infection on the kidney.Methods The retrospective studies on the relationship between CKD and the prognosis of the patients with COVID-19 were retrieved from the databases of Cochrane Library,PubMed,Medline,medRxiv and CNKI by computer,and the literature dates were from January 2020 to March 2021.The OR,WMD,and 95%CI were used as the effect sizes to measure the degree of association between CKD and SARS-CoV-2 infection.The two researchers independently extracted the data and conducted the literature quality evaluation.Then the meta-analysis was performed on the included cases.Results A total of 57 relevant literatures were included,with a total of 41235 patients.Compared with the patients with non-CKD,the patients with CKD were more likely to progress to the critical stage(OR=3.36)or die(OR=3.75)after SARS-CoV-2 infection,and the overall CKD population had a poor prognosis(OR=3.43).Compared with the patients with mild COVID-19,the patients with severe COVID-19 were more prone to acute kidney injury(AKI,OR=11.31);whereas the values of creatinine(WMD=3.70)and uric acid(WMD=1.42)in the critical patients were also significantly higher than those in the ordinary patients(P<0.01).Conclusion The patients with CKD are more likely to develop into a critical stage or die after SARS-CoV-2 infection,meanwhile the SARS-CoV-2 infection is also more likely to cause AKI and increase of creatinine and uric acid levels.