key: cord-340205-cwn0gx7h authors: Chen, Yih-Ting; Shao, Shih-Chieh; Lai, Edward Chia-Cheng; Hung, Ming-Jui; Chen, Yung-Chang title: Mortality rate of acute kidney injury in SARS, MERS, and COVID-19 infection: a systematic review and meta-analysis date: 2020-07-16 journal: Crit Care DOI: 10.1186/s13054-020-03134-8 sha: doc_id: 340205 cord_uid: cwn0gx7h nan and independently assessed the full texts of selected results. The final list of included studies was derived by discussion and unanimous agreement from both authors. Statistical analyses were performed using MedCalc for Windows, version 15.0 (MedCalc Software, Ostend, Belgium). We report the mortality rate from AKI in SARS, MERS, and COVID-19 infections as proportions with 95% confidence interval (CI) based on random effects model, represented by forest plot. We detected heterogeneity among studies using the Cochran Q test, with p value < 0.10 indicating significant heterogeneity, and calculated I 2 statistic to determine the proportion of total variation in study estimates attributable to heterogeneity. After screening 97 records in total, we excluded 74 articles (15 duplicates, 11 irrelevant to study question, 1 conference abstract, 5 review articles and 42 lacking data on AKI mortality). Our final analysis included 23 articles comprising 4, 3 and 16 on SARS, MERS and COVID-19 infection, respectively. Demographic data for included articles are presented in Table 1 . Overall, mortality in patients with SARS, MERS and COVID-19 infection, and developing AKI, was 77.4% (95%CI: 64.7-88.0). We found the mortality rate of AKI was highest in SARS (86.6%; 95%CI: 77.7-93.5), followed by COVID-19 (76.5%; 95%CI: 61.0-89.0) and MERS (68.5%; 95%CI: 53.8-81.5). There was no evidence of statistical heterogeneity among studies reporting AKI mortality in SARS (I2: 0.0%, p = 0.589) and MERS (I2: 0.0%, p =v0.758), but there was for COVID-19 infection (I2: 97.0%, p < 0.001) (Fig. 1 ). The present analyses indicate AKI as a poor prognosis factor in coronavirus infections, whereby AKI mortality in COVID-19 is higher than MERS but lower than SARS infections. Possible mechanisms of higher AKI mortality following coronavirus infections are multifactorial (e.g., severe sepsis-related multiorgan failure, direct kidney involvement, and acute respiratory distress syndrome) [26] [27] [28] , although comparative pathogenesis of kidney involvement among the three infections remains unclear. To our best knowledge, this is the first systematic review exploring AKI mortality of different coronavirus infections. However, we should be cautious about interpreting causal relationships between coronavirus infections and AKI, given the nature of observational data. Also, clinical heterogeneity between studies should be noted; for example, various healthcare systems of included studies may produce different AKI mortality rates. Coronaviruses are unlikely to be eliminated in the near future, and our synthesis indicates that AKI secondary to coronavirus infection may contribute to higher mortality. Hence, in the current exceptional pandemic, first-line healthcare providers should recognize the importance of timely detection of AKI and consider all available treatment options for maintenance of kidney functions to prevent death in COVID-19 patients [29] . Authors' contributions YCY and SCS contributed equally to this work. 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