Myocardial injury in hospitalized COVID-19 patients: a retrospective study, systematic review, and meta-analysis

Abstract Introduction The majority of studies evaluating the effect of myocardial injury on the survival of COVID-19 patients have been performed outside of the United States (U.S.). These studies have often utilized definitions of myocardial injury that are not guideline-based and thus, not applicable to the U.S. patient population. Methods The current study is a two-part investigation of the effect of myocardial injury on the clinical outcome of patients hospitalized with COVID-19. The first part is a retrospective analysis of 268 patients admitted to our healthcare system in Toledo, Ohio, U.S.; the second part is a systematic review and meta-analysis of all similar studies performed within the U.S. Results In our retrospective analysis, patients with myocardial injury were older (mean age 73 vs. 59 years, P 0.001), more likely to have hypertension (86% vs. 67%, P 0.005), underlying cardiovascular disease (57% vs. 24%, P 0.001), and chronic kidney disease (26% vs. 10%, P 0.004). Myocardial injury was also associated with a lower likelihood of discharge to home (35% vs. 69%, P 0.001), and a higher likelihood of death (33% vs. 10%, P 0.001), acute kidney injury (74% vs. 30%, P 0.001), and circulatory shock (33% vs. 12%, P 0.001). Our meta-analysis included 12,577 patients from 8 U.S. states and 55 hospitals who were hospitalized with COVID-19, with the finding that myocardial injury was significantly associated with increased mortality (HR 2.43, CI 2.28–3.6, P 0.0005). The prevalence of myocardial injury ranged from 9.2 to 51%, with a mean prevalence of 27.2%. Conclusion Hospitalized COVID-19 patients in the U.S. have a high prevalence of myocardial injury, which was associated with poorer survival and outcomes.

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A Systematic Review and Meta-Analysis of Pharmacogenetic Studies in Patients with Chronic Kidney Disease

International Journal of Molecular Sciences ◽

10.3390/ijms22094480 ◽

2021 ◽

Vol 22 (9) ◽

pp. 4480

Author(s):

Maria Tziastoudi ◽

Georgios Pissas ◽

Georgios Raptis ◽

Christos Cholevas ◽

Theodoros Eleftheriadis ◽

...

Keyword(s):

Systematic Review ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Meta Analysis ◽

Public Health Problem ◽

Response To Treatment ◽

Genotype Distribution ◽

Global Public Health ◽

High Prevalence ◽

Additive Inheritance

Chronic kidney disease (CKD) is an important global public health problem due to its high prevalence and morbidity. Although the treatment of nephrology patients has changed considerably, ineffectiveness and side effects of medications represent a major issue. In an effort to elucidate the contribution of genetic variants located in several genes in the response to treatment of patients with CKD, we performed a systematic review and meta-analysis of all available pharmacogenetics studies. The association between genotype distribution and response to medication was examined using the dominant, recessive, and additive inheritance models. Subgroup analysis based on ethnicity was also performed. In total, 29 studies were included in the meta-analysis, which examined the association of 11 genes (16 polymorphisms) with the response to treatment regarding CKD. Among the 29 studies, 18 studies included patients with renal transplantation, 8 involved patients with nephrotic syndrome, and 3 studies included patients with lupus nephritis. The present meta-analysis provides strong evidence for the contribution of variants harbored in the ABCB1, IL-10, ITPA, MIF, and TNF genes that creates some genetic predisposition that reduces effectiveness or is associated with adverse events of medications used in CKD.

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Acute kidney injury in hospitalized COVID-19 patients in Iran; a systematic review and meta-analysis

Journal of Renal Injury Prevention ◽

10.34172/jrip.2021.09 ◽

2021 ◽

Vol 10 (2) ◽

pp. e09-e09

Author(s):

Alireza Saghafi ◽

Mohammad Aghaali ◽

Hossein Saghafi

Keyword(s):

Systematic Review ◽

Acute Kidney Injury ◽

Racial Differences ◽

Outcome Measurement ◽

Meta Analysis ◽

Renal Involvement ◽

Kidney Injury ◽

The United States ◽

Hospitalized Patients ◽

Published Data

Acute kidney injury (AKI) is one of the complications in COVID-19 patients, which is reported with widely varied incidence rates in different studies and is known to have a major impact on prognosis and outcome of the disease. It is noticed that there are considerable differences in AKI rates between different countries. Rates in China are generally much lower than in Western Europe and the United States. One of the potential explanations is heterogeneity along racial and ethnic lines. This study aims to systematically investigate the scientific resources regarding AKI prevalence among hospitalized COVID-19 patients in Iran, and run a meta-analysis on currently published data. Web of Science, PubMed, Embase, Scopus, and Google Scholar databases were searched to identify the articles discussing the occurrence of AKI in hospitalized patients with COVID-19 in Iran. All observational and interventional studies with English full-text providing necessary data for analysis were included with no limitation in time of release or peer-review. Around, 4069 confirmed cases (age; 10-94) from 22 studies were included in the pooled outcome measurement. The proportion of hospitalized patients with COVID-19 in Iran who developed AKI was 24% (95% CI: 17-31%). To the best of our knowledge, this is the first systematic review and meta-analysis to measure the prevalence of AKI in hospitalized COVID-19 patients in Iran. The geographical dissimilarities in the proportion of AKI among COVID-19 patients suggest a role for ethnical and racial differences in the tendency to develop renal involvement.

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The Chronic Kidney Disease and Acute Kidney Injury Involvement in COVID-19 Pandemic: A Systematic Review and Meta-analysis

10.1101/2020.04.28.20083113 ◽

2020 ◽

Cited By ~ 3

Author(s):

Ya-Fei Liu ◽

Zhe Zhang ◽

Xiao-Li Pan ◽

Guo-Lan Xing ◽

Ying Zhang ◽

...

Keyword(s):

Systematic Review ◽

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Kidney Disease ◽

Serum Creatinine ◽

Blood Urea Nitrogen ◽

Meta Analysis ◽

Kidney Injury ◽

Urea Nitrogen ◽

Severe Group

ABSTRACTAimThe aim of this study was to uncover whether kidney diseases were involved in COVID-19 pandemic from a systematic review.MethodsThe studies reported the kidney outcomes in different severity of COVID-19 were included in this study. Standardized mean differences or odds ratios were calculated by employing Review Manager meta-analysis software.ResultsThirty-six trials were included in this systematic review with a total of 6395 COVID-19 patients. The overall effects indicated that the comorbidity of chronic kidney disease (CKD) (OR = 3.28), complication of acute kidney injury (AKI) (OR = 11.02), serum creatinine (SMD = 0.68), abnormal serum creatinine (OR = 4.86), blood urea nitrogen (SMD = 1.95), abnormal blood urea nitrogen (OR = 6.53), received continuous renal replacement therapy (CRRT) (OR = 23.63) was significantly increased in severe group than that in nonsevere group. Additionally, the complication of AKI (OR = 13.92) and blood urea nitrogen (SMD = 1.18) were remarkably elevated in critical group than that in severe group.ConclusionCKD and AKI are susceptible to occur in patients with severe COVID-19. CRRT is applied frequently in severe COVID-19 patients than that in nonsevere COVID-19 patients. The risk of AKI is higher in critical group than that in severe group.

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SES, Chronic Kidney Disease, and Race in the U.S.: A Systematic Review and Meta-analysis

American Journal of Preventive Medicine ◽

10.1016/j.amepre.2017.06.036 ◽

2017 ◽

Vol 53 (5) ◽

pp. 730-739 ◽

Cited By ~ 11

Author(s):

Priya Vart ◽

Sander K.R. van Zon ◽

Ron T. Gansevoort ◽

Ute Bültmann ◽

Sijmen A Reijneveld

Keyword(s):

Systematic Review ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Meta Analysis ◽

The U.S

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Non-steroidal anti-inflammatory drug induced acute kidney injury in the community dwelling general population and people with chronic kidney disease: systematic review and meta-analysis

BMC Nephrology ◽

10.1186/s12882-017-0673-8 ◽

2017 ◽

Vol 18 (1) ◽

Cited By ~ 67

Author(s):

Xinyu Zhang ◽

Peter T Donnan ◽

Samira Bell ◽

Bruce Guthrie

Keyword(s):

Systematic Review ◽

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Kidney Disease ◽

General Population ◽

Meta Analysis ◽

Kidney Injury ◽

Community Dwelling ◽

Drug Induced ◽

Inflammatory Drug

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The chronic kidney disease and acute kidney injury involvement in COVID-19 pandemic: A systematic review and meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0244779 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0244779

Author(s):

Ya-Fei Liu ◽

Zhe Zhang ◽

Xiao-Li Pan ◽

Guo-Lan Xing ◽

Ying Zhang ◽

...

Keyword(s):

Systematic Review ◽

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Kidney Disease ◽

Serum Creatinine ◽

Blood Urea Nitrogen ◽

Meta Analysis ◽

Kidney Injury ◽

Urea Nitrogen ◽

Severe Group

Background Currently, the SARS-CoV-2 promptly spread across China and around the world. However, there are controversies about whether preexisting chronic kidney disease (CKD) and acute kidney injury complication (AKI) are involved in the COVID-19 pandemic. Measurements Studies reported the kidney outcomes in different severity of COVID-19 were included in this study. Standardized mean differences or odds ratios were calculated by employing Review Manager meta-analysis software. Results Thirty-six trials were included in this systematic review with a total of 6395 COVID-19 patients. The overall effects indicated that preexisting CKD (OR = 3.28), complication of AKI (OR = 11.02), serum creatinine (SMD = 0.68), abnormal serum creatinine (OR = 4.86), blood urea nitrogen (SMD = 1.95), abnormal blood urea nitrogen (OR = 6.53), received continuous renal replacement therapy (CRRT) (OR = 23.63) were significantly increased in severe group than that in nonsevere group. Additionally, the complication of AKI (OR = 13.92) and blood urea nitrogen (SMD = 1.18) were remarkably elevated in the critical group than that in the severe group. Conclusions CKD and AKI are susceptible to occur in patients with severe COVID-19. CRRT is applied frequently in severe COVID-19 patients than that in nonsevere COVID-19 patients. The risk of AKI is higher in the critical group than that in the severe group.

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

Canadian Journal of Kidney Health and Disease ◽

10.1177/2054358120938573 ◽

2020 ◽

Vol 7 ◽

pp. 205435812093857 ◽

Cited By ~ 8

Author(s):

Michael Anthonius Lim ◽

Raymond Pranata ◽

Ian Huang ◽

Emir Yonas ◽

Arto Yuwono Soeroto ◽

...

Keyword(s):

Systematic Review ◽

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Cardiovascular Diseases ◽

Acute Liver Injury ◽

Meta Analysis ◽

Kidney Injury ◽

Composite Outcome ◽

Poor Outcomes ◽

Definition Of

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.

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