A Multi-Center Retrospective Study of Clinical features, Laboratory Characteristics, and Outcomes of 325 Hospitalized Children with Coronavirus Disease 2019 (COVID-19); A Preliminary Report from Iranian Network for Research in Viral Diseases (INRVD)

Abstract Background: The objectives of this study were to analyze the clinical features and laboratory profiles and risk factors associated with critical illness of children with SARS-CoV-2.Methods: 325 COVID-19 pediatric patients were recruited through a collaborative research network between March and May 2020. Demographics, clinical, laboratory, and radiological results were obtained from patient files. Results: Of 325 patients, 189 (58%) and 136 (42%) were males and females, respectively. The mean age was 6.18 ± 4.99. 195 (60%) and 130 (40%), had moderate and severe conditions, respectively. 45 (13.9%) of patients died. The common symptoms were fever (72.6%), cough (59%) and shortness of breath (36%). 254 (78%) and 145 (44.6%( had gastrointestinal and neurological symptoms, respectively. Shortness of breath, rhinorrhea, nausea/vomiting, decrease in platelet counts; increase values in C-reactive protein, lactate dehydrogenase (LDH), and blood urea nitrogen, decrease in the blood PH and HCo3 were significantly associated with the disease severity. 58.2% and 65.4% of patients showed abnormal radiographic appearance in Chest X-ray and in chest CT scan, respectively, which were correlated with disease severity. 104 (32%) of patients referred to ICU. The coexistence of comorbidity was the main factor associated with ICU admission, shock, arrhythmia, acute kidney injury, acute respiratory distress syndrome (ARDS), acute cardiac injury, and death. Conclusions: We describe a higher than previously recognized rate of COVID-19 mortality in Iranian pediatric patients. Epidemiological factors, such as relatively high case fatality rate in the country and the presence of underlying diseases are the main factors for the high death rate.

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Clinical Features of Maintenance Hemodialysis Patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.04160320 ◽

2020 ◽

Vol 15 (8) ◽

pp. 1139-1145 ◽

Cited By ~ 21

Author(s):

Jun Wu ◽

Jushuang Li ◽

Geli Zhu ◽

Yanxia Zhang ◽

Zhimin Bi ◽

...

Keyword(s):

Clinical Features ◽

Troponin I ◽

Clinical Laboratory ◽

Cardiac Injury ◽

Hemodialysis Patients ◽

Hospitalized Patients ◽

Maintenance Hemodialysis ◽

Computed Tomographic ◽

Risk Of Death ◽

Novel Coronavirus

Background and objectivesPrevious reports on the outbreak of coronavirus disease 2019 were on the basis of data from the general population. Our study aimed to investigate the clinical features of patients on maintenance hemodialysis.Design, setting, participants, & measurements In this retrospective, single-center study, we included 49 hospitalized patients on maintenance hemodialysis and 52 hospitalized patients without kidney failure (controls) with confirmed coronavirus disease 2019 at Tongren Hospital of Wuhan University from January 30, 2020 to March 10, 2020. Demographic, clinical, laboratory, and radiologic characteristics and treatment and outcomes data were analyzed. The final date of follow-up was March 19, 2020.ResultsThe median age of 101 patients was 62 years (interquartile range, 49–72). All patients were local residents of Wuhan. In terms of common symptoms, there were differences between patients on hemodialysis and controls (fatigue [59% versus 83%], dry cough [49% versus 71%], and fever [47% versus 90%]). Lymphocyte counts were decreased (0.8×109/L [patients on hemodialysis] versus 0.9×109/L [controls], P=0.02). Comparing patients on hemodialysis with controls, creatine kinase–muscle and brain type, myoglobin, hypersensitive troponin I, B-type natriuretic peptide, and procalcitonin were increased, and the percentage of abnormalities in bilateral lung was higher in computed tomographic scan (82% versus 69%, P=0.15) and unilateral lung was lower (10% versus 27%, P=0.03). Common complications including shock, acute respiratory distress syndrome, arrhythmia, and acute cardiac injury in patients on hemodialysis were significantly higher. Compared with controls, more patients on hemodialysis received noninvasive ventilation (25% versus 6%, P=0.008). As of March 19, 2020, three patients on hemodialysis (6%) were transferred to the intensive care unit and received invasive ventilation. Seven patients on hemodialysis (14%) had died.ConclusionsThe main symptoms of coronavirus disease 2019 pneumonia, including fever and cough, were less common in patients on hemodialysis. Patients on hemodialysis with coronavirus disease 2019 were at higher risk of death.

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Comorbid Chronic Diseases and Acute Organ Injuries Are Strongly Correlated with Disease Severity and Mortality among COVID-19 Patients: A Systemic Review and Meta-Analysis

Research ◽

10.34133/2020/2402961 ◽

2020 ◽

Vol 2020 ◽

pp. 1-17 ◽

Cited By ~ 29

Author(s):

Xinhui Wang ◽

Xuexian Fang ◽

Zhaoxian Cai ◽

Xiaotian Wu ◽

Xiaotong Gao ◽

...

Keyword(s):

High Risk ◽

Disease Severity ◽

Clinical Data ◽

Meta Analysis ◽

Cardiac Injury ◽

Supportive Therapy ◽

Kidney Injury ◽

Global Scale ◽

Systemic Review ◽

Increased Risk

The recent outbreak of COVID-19 has been rapidly spreading on a global scale. To date, there is no specific vaccine against the causative virus, SARS-CoV-2, nor is there an effective medicine for treating COVID-19, thus raising concerns with respect to the effect of risk factors such as clinical course and pathophysiological parameters on disease severity and outcome in patients with COVID-19. By extracting and analyzing all available published clinical data, we identified several major clinical characteristics associated with increased disease severity and mortality among patients with COVID-19. Specifically, preexisting chronic conditions such as hypertension, cardiovascular disease, chronic kidney disease, and diabetes are strongly associated with an increased risk of developing severe COVID-19; surprisingly, however, we found no correlation between chronic liver disease and increased disease severity. In addition, we found that both acute cardiac injury and acute kidney injury are highly correlated with an increased risk of COVID-19-related mortality. Given the high risk of comorbidity and the high mortality rate associated with tissue damage, organ function should be monitored closely in patients diagnosed with COVID-19, and this approach should be included when establishing new guidelines for managing these high-risk patients. Moreover, additional clinical data are needed in order to determine whether a supportive therapy can help mitigate the development of severe, potentially fatal complications, and further studies are needed to identify the pathophysiology and the mechanism underlying this novel coronavirus-associated infectious disease. Taken together, these findings provide new insights regarding clinical strategies for improving the management and outcome of patients with COVID-19.

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Clinical Features and Outcomes of Acute Kidney Injury in Patients Infected with COVID-19 in Xiangyang, China

Blood Purification ◽

10.1159/000513163 ◽

2020 ◽

pp. 1-7

Author(s):

Hai Yuan ◽

Jingjing Liu ◽

Zhao Gao ◽

Fengqi Hu

Keyword(s):

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Clinical Features ◽

Clinical Laboratory ◽

Antiviral Treatment ◽

Kidney Injury ◽

Ground Glass Opacity ◽

Ct Images ◽

Additional Time

Background: In December 2019, pneumonia associated with COVID-19 has spread from Wuhan to other areas in China. In the present study, we aimed to further clarify the clinical features and outcomes of acute kidney injury (AKI) in patients infected with COVID-19 in Xiangyang, Hubei, China. Methods: All confirmed cases of COVID-19 with AKI in Xiangyang Central Hospital from January 22 to May 31, 2020, were included in this retrospective study. Data of epidemiological, clinical, laboratory, radiological tests, treatment, complication, and outcomes were collected and analyzed. Patients were divided into intensive care unit (ICU) group and isolation ward (non-ICU) group. Results: Of the total patients, 33.3% in the non-ICU group and 85.7% in the ICU group had chronic diseases. In addition, 85.7% of patients in the ICU group died. The most common symptoms were fever, cough, and fatigue. The lymphocyte count in the ICU group was significantly reduced compared with the non-ICU group. The chest computed tomography (CT) images appeared showed multiple mottles and ground-glass opacity. Strip shadow could be found in chest CT images of some recovered patients. All patients received antiviral treatment. Most patients in the ICU group were given methylprednisolone, immunoglobulin, antibiotics, and mechanical ventilation and 35.7% of patients in the ICU group received continuous renal replacement therapy. Conclusions: Elderly with chronic comorbidities were more susceptible to COVID-19, showing a higher mortality rate due to multiple organ damage, and 35.7% of patients with AKI in ICU received renal replacement therapy. Moreover, part of the cured patients might need additional time to recover for poor lung function.

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Clinical features, treatments and outcomes of severe and critical severe patients infected with COVID-19: A system review and meta-analysis

10.21203/rs.3.rs-17307/v1 ◽

2020 ◽

Cited By ~ 1

Author(s):

Hai-yue Zhang ◽

Fang-zhou Jiao ◽

Xiao-jun Wu ◽

Min Shang ◽

Yu-chuan Luo ◽

...

Keyword(s):

Clinical Features ◽

Clinical Laboratory ◽

Meta Analysis ◽

Invasive Mechanical Ventilation ◽

Cardiac Injury ◽

Fatal Outcome ◽

Fixed Effect Model ◽

Utilization Rate ◽

Imaging Features ◽

Multiple Organs

Abstract Backgrounds: The outbreak of COVID-19 caused by a novel coronavirus, SARS-CoV-2, has been listed as a public health emergency of international concern by WHO. Most COVID-19 patients presented with a mild infection, but many challenges exist in therapy of severe and critical severe patients. This paper systematically reviewed clinical features, treatments and outcomes of severe and critical severe patients infected COVID-19. Methods: The clinical, laboratory, imaging features, treatment and outcomes of COVID-19 were collected. The data were analyzed by using STATA 15 statistical software to estimate the prevalence and 95% CI in severe and critical severe patients with COVID-19. A random or fixed effect model was used to estimate the prevalence and 95% CI. Results: After screening, 8 studies including a total of 275 patients were included in this meta-analysis. The percentage of severe and critical severe patients in confirmed COVID-19 cases was 25% (95% CI 16-36%). Fever, cough, dyspnea, lymphopenia and bilateral distribution of patchy shadows were the most prevalent findings in these patients. Utilization rate of antiviral drugs, corticosteroid, non-invasive ventilation, invasive mechanical ventilation was high in therapy strategies. The most prevalent complications were ARDS, shock, and acute cardiac injury. Discussion: Severe and critical severe COVID-19 patients usually had complications even a fatal outcome. As vaccines and anti-coronaviral drugs are under development, the principles of treatment for these patients should be focused on improving oxygenation, lung protective and function support of multiple organs.

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Evidence for the utility of cfDNA plasma concentrations to predict disease severity in COVID-19

10.1101/2021.04.29.21256291 ◽

2021 ◽

Author(s):

Katharina Hoeter ◽

Elmo Neuberger ◽

Susanne Fischer ◽

Manuel Herbst ◽

Ema Juškevičiūtė ◽

...

Keyword(s):

Disease Severity ◽

Clinical Laboratory ◽

Medical Center ◽

Plasma Concentrations ◽

Kidney Injury ◽

Predictive Biomarker ◽

Neurological Complications ◽

Reactive Protein ◽

Heparin Plasma ◽

The University

AbstractCOVID-19 is a pandemic caused by the highly infective SARS-CoV-2. There is a need for biomarkers not only for overall prognosis but also for predicting the response to treatments and thus for improvements in the clinical management of patients with COVID-19. Circulating cell-free DNA (cfDNA) has emerged as a promising biomarker in the assessment of various disease conditions. The aim of this retrospective and observational pilot study was to examine the potential value of cfDNA plasma concentrations as a correlative biomarker in hospitalized COVID-19 patients. Lithium-Heparin plasma samples were obtained from twenty-one COVID-19 patients during hospitalization in the University Medical Center of Mainz, Germany, and the cfDNA concentrations were determined by quantitative PCR yielding amplicons of long interspersed nuclear elements (LINE-1). cfDNA plasma concentrations of COVID-19 patients ranged between 247.5 and 6346.25 ng/ml and the mean concentrations were 1831 ± 1388 ng/ml (± standard deviation). Correlations were found between cfDNA levels and the occurrence of acute respiratory distress symptom (ARDS), acute kidney injury (AKI), myositis, neurological complications, bacterial superinfection and disease severity as defined by sepsis-related organ failure assessment score (SOFA) score. D-Dimer and C-reactive-protein (CRP), determined by clinical laboratory analysis, showed the highest correlations with cfDNA levels. The results of this observational study suggest that cfDNA plasma concentrations may serve as a predictive biomarker of disease severity in COVID-19. Prospective studies enrolling larger patient cohorts are ongoing to test this hypothesis.

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Identification of Symptoms Prognostic of COVID-19 Severity: Multivariate Data Analysis of a Case Series in Henan Province

Journal of Medical Internet Research ◽

10.2196/19636 ◽

2020 ◽

Vol 22 (6) ◽

pp. e19636 ◽

Cited By ~ 7

Author(s):

Jitian Li ◽

Zhe Chen ◽

Yifei Nie ◽

Yan Ma ◽

Qiaoyun Guo ◽

...

Keyword(s):

Disease Severity ◽

Statistical Significance ◽

Case Series ◽

Case Fatality ◽

Severe Infection ◽

Individual Characteristics ◽

Henan Province ◽

Shortness Of Breath ◽

Older Individuals ◽

Male Patients

Background The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease (COVID-19), has been declared a global pandemic. Identifying individuals whose infection can potentially become severe is critical to control the case fatality rate of COVID-19. However, knowledge of symptoms that are prognostic of COVID-19 severity is lacking. Objective The objective of our study was to identify symptoms prognostic of COVID-19 infection severity. Methods We analyzed documented symptoms, including fever, cough, fatigue, expectoration, sore throat, chest distress, headache, diarrhea, rhinorrhea, stuffed nose, nausea, vomiting, muscle or joint ache, shortness of breath, and their associations with disease severity using a case series, including 655 confirmed cases from January 23 to February 5, 2020 in Henan Province, China. We also analyzed the influence of individual characteristics, including age, gender, and comorbidities, on symptoms with prognostic value. Results Fatigue (95% CI 0.141 to 0.334, P<.001), expectoration (95% CI 0.107 to 0.305, P<.001) and stuffed nose (95% CI –0.499 to –0.082, P=.006) were identified as the prognostic symptoms of COVID-19 patients from the multivariate analysis. Fever occurred in 603/655 (92.1%) of the patients but was not associated with disease severity. Fatigue accounted for 184/655 (28.1%) of the patients and was linearly associated with infection severity with statistical significance. Expectoration occurred in 169/655 (25.8%) patients in the cohort and was the sole prognostic factor for patients with cardiovascular complications, including hypertension. Shortness of breath, chest distress, muscle or joint ache, and dry cough, which occurred in 33 (5%), 83 (12.7%), 78 (11.9%), and 276 (42.1%) of the 655 patients, respectively, were significantly enriched among patients classified as severe. Stuffed nose and nausea were associated with favorable disease severity, especially among male patients. More female than male patients were documented as having muscle or joint ache. Headache was most enriched in patents aged 15 to 39 years, followed by those aged 40 to 64 years, with statistical significance. Conclusions Fatigue and expectoration are signs of severe COVID-19 infection. Shortness of breath, chest distress, muscle or joint ache, and dry cough are prevalent in severe patients. Expectoration is commonly present in older individuals and patients with cardiovascular disorders, including hypertension. Shortness of breath is prognostic of severe infection in male patients. Stuffed nose and nausea are favorable prognostic factors of severe infection, especially among male patients.

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Evaluation of the Clinical Features of 81 Patients with COVID-19: An Unpredictable Disease in Children

Journal of Pediatric Infectious Diseases ◽

10.1055/s-0040-1721511 ◽

2020 ◽

Author(s):

Hayrettin Temel ◽

Mehmet Gündüz ◽

Hüseyin Arslan ◽

Füsun Ünal ◽

Emine Atağ ◽

...

Keyword(s):

Clinical Features ◽

Pediatric Patients ◽

Clinical Laboratory ◽

Tertiary Care ◽

Age Groups ◽

Signs And Symptoms ◽

Asymptomatic Infection ◽

Care Hospital ◽

Significant Difference ◽

History Of

Abstract Objective Data on the prognosis of clinical features of pediatric patients affected by the coronavirus disease 2019 (COVID-19) pandemic is insufficient. This study aimed to examine the clinical, laboratory, and radiology findings of pediatric patients diagnosed with COVID-19. Methods A total of 81 pediatric patients with a confirmed diagnosis of COVID-19 who were admitted to the pediatric clinics of our tertiary care hospital in Istanbul between March 22 and May 1, 2020, were included in the study. Results Of the patients, 40 (49.6%) were boys and 41 (50.6%) were girls. The mean age of the patients was 9.3 ± 5.5 years (range: 1 month–16 years). The most common symptoms were cough (28.4%) and fever (25.9%). A total of 26 patients (32.1%) had pharyngeal erythema. There was no significant difference between age groups in terms of symptoms, findings, clinical picture, history of contact, and clinical course (p > 0.001 for each). Abnormal findings were observed in seven (8.6%) patients on chest X-ray, and in four patients (4.9%) on thorax computed tomography. Only three of the patients were hospitalized and all of them discharged with healing. Conclusion The present study is the most comprehensive study on children diagnosed with COVID-19 in our country, which showed that the COVID-19 picture was mild in pediatric patients, but the signs and symptoms in children were not specific to the disease. Our findings also showed that the rate of asymptomatic infection in children was high and that it was difficult to recognize COVID-19 in children.

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Identification of Symptoms Prognostic of COVID-19 Severity: Multivariate Data Analysis of a Case Series in Henan Province (Preprint)

10.2196/preprints.19636 ◽

2020 ◽

Cited By ~ 2

Author(s):

Jitian Li ◽

Zhe Chen ◽

Yifei Nie ◽

Yan Ma ◽

Qiaoyun Guo ◽

...

Keyword(s):

Disease Severity ◽

Statistical Significance ◽

Case Series ◽

Case Fatality ◽

Severe Infection ◽

Individual Characteristics ◽

Henan Province ◽

Shortness Of Breath ◽

Older Individuals ◽

Male Patients

BACKGROUND The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease (COVID-19), has been declared a global pandemic. Identifying individuals whose infection can potentially become severe is critical to control the case fatality rate of COVID-19. However, knowledge of symptoms that are prognostic of COVID-19 severity is lacking. OBJECTIVE The objective of our study was to identify symptoms prognostic of COVID-19 infection severity. METHODS We analyzed documented symptoms, including fever, cough, fatigue, expectoration, sore throat, chest distress, headache, diarrhea, rhinorrhea, stuffed nose, nausea, vomiting, muscle or joint ache, shortness of breath, and their associations with disease severity using a case series, including 655 confirmed cases from January 23 to February 5, 2020 in Henan Province, China. We also analyzed the influence of individual characteristics, including age, gender, and comorbidities, on symptoms with prognostic value. RESULTS Fatigue (95% CI 0.141 to 0.334, P<.001), expectoration (95% CI 0.107 to 0.305, P<.001) and stuffed nose (95% CI –0.499 to –0.082, P=.006) were identified as the prognostic symptoms of COVID-19 patients from the multivariate analysis. Fever occurred in 603/655 (92.1%) of the patients but was not associated with disease severity. Fatigue accounted for 184/655 (28.1%) of the patients and was linearly associated with infection severity with statistical significance. Expectoration occurred in 169/655 (25.8%) patients in the cohort and was the sole prognostic factor for patients with cardiovascular complications, including hypertension. Shortness of breath, chest distress, muscle or joint ache, and dry cough, which occurred in 33 (5%), 83 (12.7%), 78 (11.9%), and 276 (42.1%) of the 655 patients, respectively, were significantly enriched among patients classified as severe. Stuffed nose and nausea were associated with favorable disease severity, especially among male patients. More female than male patients were documented as having muscle or joint ache. Headache was most enriched in patents aged 15 to 39 years, followed by those aged 40 to 64 years, with statistical significance. CONCLUSIONS Fatigue and expectoration are signs of severe COVID-19 infection. Shortness of breath, chest distress, muscle or joint ache, and dry cough are prevalent in severe patients. Expectoration is commonly present in older individuals and patients with cardiovascular disorders, including hypertension. Shortness of breath is prognostic of severe infection in male patients. Stuffed nose and nausea are favorable prognostic factors of severe infection, especially among male patients.

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Clinical features and disease severity in an Iranian population of COVID-19 patients

10.21203/rs.3.rs-51568/v1 ◽

2020 ◽

Author(s):

Shima Nabavi ◽

Zahra Javidarabshahi ◽

Abolghasem Allahyari ◽

Mohammad Ramezani ◽

Mohsen Seddigh-Shamsi ◽

...

Keyword(s):

Disease Severity ◽

Clinical Features ◽

Clinical Laboratory ◽

Severe Disease ◽

Cross Sectional Study ◽

Cross Sectional ◽

Reactive Protein ◽

Radiologic Findings ◽

Severity Of The Disease ◽

Lung Ct

Abstract Objectives: Coronavirus disease 2019 (COVID-19) can present with a variety of symptoms. Severity of the disease may be associated with several factors. Here, we review clinical features of COVID-19 patients with different severities.Methods: This cross-sectional study was performed in Imam Reza hospital, Mashhad, Iran, during February-April 2020. COVID-19 patients with typical computed tomography (CT) patterns and/or positive reverse-transcriptase polymerase chain reaction (RT-PCR) were included. The patients were classified into three groups of moderate, severe, and critical based on disease severity. Demographic, clinical, laboratory, and radiologic findings were collected and compared. P<0.05 was considered statistically significant.Results: Overall, 200 patients with mean age of 69.75±6.39 years, of whom 82 (41%) were female were studied. Disease was severe/critical in the majority of patients (167, 83.5%). Disease severity was significantly associated with age, malignant comorbidities, dyspnea, nausea/vomiting, confusion, respiratory rate, pulse rate, O2 saturation, extent of CT involvement, serum C-reactive protein (CRP), pH, pO2, and aspartate transaminase (P<0.05). Moreover, complications including shock, coagulopathy, acidosis, sepsis, acute respiratory distress syndrome (ARDS), intensive care unit (ICU) admission, and intubation were significantly higher in patients with higher severities. O2 saturation, nausea/vomiting, and extent of lung CT involvement were independent predictors of severe/critical COVID-19 (OR=0.342, 45.93, and 25.48, respectively; P<0.05).Conclusions: Our results indicate O2 saturation, nausea/vomiting, and extent of lung CT involvement as independent predictors of severe COVID-19 conditions. Serum CRP levels and pO2 were also considerably higher patients with higher severity and can be used along with other factors as possible predictors of severe disease in COVID-19 patients.

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The Involvement of Chronic Kidney Disease and Acute Kidney Injury in Disease Severity and Mortality in Patients with COVID-19: A Meta-Analysis

Kidney & Blood Pressure Research ◽

10.1159/000512211 ◽

2020 ◽

pp. 1-14

Author(s):

Bin Wang ◽

Qing Luo ◽

Weiguang Zhang ◽

Shuai Yu ◽

Xiaowei Cheng ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Kidney Disease ◽

Disease Severity ◽

Meta Analysis ◽

Kidney Injury ◽

Research Network ◽

Cochrane Library ◽

Severe Condition ◽

Increased Risk

Background: A meta-analysis was performed to evaluate the association of chronic kidney disease (CKD) and acute kidney injury (AKI) with the clinical prognosis of patients with coronavirus disease 2019 (COVID-19). Methods: The PubMed, EMBASE, Cochrane Library, medRxiv, Social Science Research Network, and Research Square databases (from December 1, 2019 to May 15, 2020) were searched to identify studies that reported the associations of CKD/AKI and disease severity/mortality. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated and meta-regression was performed. Results: In total, 42 studies enrolling 8,932 participants were included in this meta-analysis. The quality of most included studies was moderate to high. Compared with patients without previously diagnosed CKD, those with CKD had a significantly increased risk of progressing to a severe condition (OR 2.31, 95% CI 1.64–3.24) or death (OR 5.11, 95% CI 3.36–7.77). Similarly, compared with patients without AKI, those with AKI had a significantly increased risk of progressing to a severe condition (OR 11.88, 95% CI 9.29–15.19) or death (OR 30.46, 95% CI 18.33–50.59). Compared with patients with previously diagnosed CKD, those with AKI were more likely to progress to a severe condition (pgroup < 0.001, I2 = 98.3%) and even to death (pgroup < 0.001, I2 = 96.5%). Age had a significant impact on the association between CKD and disease severity (p = 0.001) but had no impact on the associations between AKI and disease severity (p = 0.80), between CKD and mortality (p = 0.51), or between AKI and mortality (p = 0.86). Four important complications (cardiac injury, shock, acute respiratory distress syndrome, and liver injury) did not significantly affect the associations between CKD/AKI and disease severity/mortality, indicating that CKD/AKI may be independent clinical prognostic indicators for patients with COVID-19. Conclusions: In COVID-19 patients, CKD/AKI was associated with worse outcomes compared with those without CKD/AKI. AKI was associated with higher risks of severity and mortality than CKD.

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