Prognosis of COVID-19 in Patients with Liver and Kidney Diseases: An Early Systematic Review and Meta-Analysis

Abstract

The mortality and severity in COVID-19 is increased in patients with comorbidities. The aim of this study was to evaluate the severity and mortality in COVID-19 patients with underlying kidney and liver diseases. We retrieved data on the clinical features and primary composite end point of COVID-19 patients from Medline and Embase which had been released from inception by the April 16, 2020. The data on two comorbidities, liver diseases and chronic kidney disease, were pooled and statistically analysed to explain the associated severity and mortality rate. One hundred and forty-two abstracts were screened, and 41 full articles were then read. In total, 22 studies including 5595 COVID-19 patients were included in this study with case fatality rate of 16%. The prevalence of liver diseases and chronic kidney disease (CKD) were 3% (95% CI; 2–3%) and 1% (95% CI; 1–2%), respectively. In patients with COVID-19 and underlying liver diseases, 57.33% (43/75) of cases were severe, with 17.65% mortality, while in CKD patients, 83.93% (47/56) of cases were severe and 53.33% (8/15) mortality was reported. This study found an increased risk of severity and mortality in COVID-19 patients with liver diseases or CKD. This will lead to better clinical management and inform the process of implementing more stringent preventative measures for this group of patients.

Prevalence of chronic liver disease in patients with COVID-19 and their clinical outcomes: a systematic review and meta-analysis

“…An EMR based, propensity matched, study had recently reported higher mortality in 250 patients with CLD and our findings corroborate it [14]. Moreover, meta-analyses of early data, one based on 11 observational studies [15] and another one based on 22 studies [16], had also come to similar conclusions. We can only speculate that some of these observations could be related to decompensation precipitated by COVID-19 in those with advanced cirrhosis or perhaps related other comorbidities in the population with liver disease.…”

Effect of COVID-19 on Kidney Disease Incidence and Management

“…Cohorts from China, however, reported lower rates of pre-existing CKD-ND, 0.7% to 4.3% One Chinese meta-analysis of four studies (N=1,389), found an association between CKD-ND and more severe COVID-19 disease (58). Other meta-analyses showed that CKD was associated with an increased risk of mortality in patients hospitalized with COVID-19, although it is not clear whether models were adjusted for hypertension or diabetes mellitus (59,60). A large, multi-center U.S. study of COVIDpositive ICU patients also revealed that patients with pre-existing CKD-ND vs. without had a higher risk of in-hospital mortality (61).…”

<p>Global Current Practices of Ventilatory Support Management in COVID-19 Patients: An International Survey</p>

“…9 In general, the severity of COVID-19 and admission to ICU are linked to various comorbidities, including chronic respiratory, cardiovascular and digestive diseases. [10][11][12] These comorbidities are also associated with an increased rate of mortality and present a challenge for ICU management of COVID-19 patients. 13 In another study, Guan et al found that about 6.1% of 1099 positive cases had received mechanical ventilation (MV), in which non-invasive ventilation (NIV) was used the most, even though nosocomial transmission with NIV and high flow nasal cannula (HFNC) is still unclear.…”