Risk Factors for Acute Kidney Injury in Patients with Coronavirus Disease 2019 (COVID-19): A Meta-Analysis

BackgroundAcute kidney injury (AKI) frequently develops in patients with Coronavirus Disease 2019 and is associated with poor outcome. Unfortunately, risk factors for AKI in COVID-19 have not been clearly elucidated. Clinical evidence is required to identify risk factors for AKI and to adopt appropriate management strategies during early COVID-19 intervention.MethodThe PubMed, MEDLINE, Web of Science, EMBASE, Google Scholar, Scopus, and Elsevier Science direct were systematically searched up to September 2020. The studies that reported risk factors for AKI in patients with COVID-19 were included. Statistical analysis was performed using Review Manager Software (RevMan 5.3). Pool odds ratio (OR) with 95% confidence interval (CI) were assessed for each risk factor.ResultsEleven studies with 8815 COCID-19 patients fulfilled eligibility criteria were incorporated into the meta-analysis, and sixteen risk factors related to AKI in patients with COVID-19 were included and analyzed. The following variables probably correlated with an increased risk of AKI in COVID-19 patients: male (OR=1.62, 95% CI, 1.24-2.13, P<0.05), mechanical ventilation (OR=9.44, 95% CI, 5.16-17.27, P<0.05), ICU admission (OR=10.57, 95%CI, 9.33-11.98, P<0.00001), use of vasopressor (OR=19.36, 95%CI, 16.77-22.34, P<0.00001), obesity (OR =1.75 ,95%CI, 1.58-1.95, p<0.00001), diabetes (OR= 1.73, 95% CI, 1.57-1.90, p<0.00001), hypertension (OR=1.53 , 95% CI, 1.04-2.20, p=0.03), cardiac disease (OR = 1.71, 95% CI, 1.51-1.94, p<0.00001), CKD (OR=2.86, 95%CI, 1.54-5.32, p=0.0009), and COPD (OR= 1.7 ,95% CI, 1.40-2.07, p<0.00001). The factors RAAS inhibitors use, cerebrovascular disease and malignancy were not significantly associated with AKI in patients with COVID-19.ConclusionsOur meta-analysis revealed a variety of risk factors for AKI in patients with COVID-19. There findings strengthened clinical awareness of early warning to identify COVID-19 patients with high risk for AKI.

First Cryptosporidium outbreak in Hungary, linked to a treated recreational water venue in 2015

In June 2015, an outbreak of cryptosporidiosis with 35 cases (23 probable and 12 laboratory-confirmed) occurred among 191 attendees of a residential rehabilitation holiday for paediatric organ transplant patients (n = 49) and their families at a hotel in Somogy county, Hungary. The overall attack rate was 18%. Most of the cases were transplanted children who experienced severe acute disease and required adjustment to their tacrolimus immunosuppression. A retrospective case-control study suggested an association between recreational water exposures and illness: cases were seven times more likely than controls to have swum in the children's pool (odds ratio 7.17; 95% confidence interval 2.9–17.2; P < 0.0001) and five times more likely to have used the jetted whirlpool (odds ratio 5.25; 95% confidence interval 2.1–13.1; P < 0.0001). This was the first outbreak of cryptosporidiosis in Hungary and it is especially unfortunate that it affected vulnerable children who experienced severe symptoms. Cryptosporidium presents specific infection control difficulties in treated recreational water venues; the link to a whirlpool is unusual and highlights the importance of the age-appropriate use of these facilities and reminding users not to immerse their heads or swallow the water. Cryptosporidiosis is more commonly linked to children’ pools where improved bather hygiene and promoting exclusion of diarrhoea cases could help to avoid similar outbreaks.