Prevalence and mortality of acute kidney injury in scrub typhus: A systematic review and metaanalysis

Prakasini Satapathy PhD, MPH¹Abhay M Gaidhane Gaidhane²Nasir Vadia³Soumya V Menon⁴Kattela Chennakesavulu⁵Rajashree Panigrahi⁶Suraj Tiwari⁷Sanjit Sah⁸Riyaz Khan P⁹S Govinda Rao¹⁰Khang Wen Goh¹¹Rachana Mehta¹²Muhammed Shabil¹³Mahendra Singh¹⁴Ganesh Bushi^15*

• ¹Saveetha Medical College & Hospital, Chennai, Tamil Nadu, India
• ²Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
• ³Marwadi University, Rajkot, Gujarat, India
• ⁴Jain University, Bengaluru, Karnataka, India
• ⁵Sathyabama Institute of Science and Technology, Chennai, Tamil Nadu, India
• ⁶Siksha O Anusandhan University, Bhubaneswar, Odisha, India
• ⁷National Institute of Pharmaceutical Education and Research, Mohali, Mohali, Punjab, India
• ⁸Dr Ulhas Patil Medical College and Hospital, Jalgaon, Maharashtra, India
• ⁹Chitkara University, Chandigarh, Punjab, India
• ¹⁰Gokaraju Rangaraju Institute of Engineering and Technology (GRIET), Hyderabad, Telangana, India
• ¹¹INTI International University, Nilai, Negeri Sembilan Darul Khusus, Malaysia
• ¹²Manav Rachna International Institute of Research and Studies (MRIIRS), Faridabad, Haryana, India
• ¹³Chandigarh University, Mohali, Punjab, India
• ¹⁴Graphic Era University, Dehradun, Uttarakhand, India
• ¹⁵Lovely Professional University, Phagwara, Punjab, India

Background: Scrub typhus, caused by Orientia tsutsugamushi, is a major public health concern in endemic regions, often complicated by acute kidney injury (AKI). Despite its significant burden, the prevalence and mortality of AKI in scrub typhus remain incompletely understood. This systematic review and meta-analysis aimed to quantify the prevalence and mortality associated with AKI in scrub typhus patients. Methods: A comprehensive literature search was conducted in PubMed, Embase, and Web of Science up to October 2024. Eligible studies reporting AKI prevalence and mortality in scrub typhus patients were included. Pooled prevalence and mortality estimates were calculated using a random-effects meta-analysis. Heterogeneity was assessed using the I² statistic, and publication bias was evaluated using Doi plots and the LFK index. Results: Fifty-one studies comprising 10,763 patients were included. The pooled prevalence of AKI was 18.29% (95% CI: 14.17%–22.79%; I² = 96.7%). In 16 studies reporting mortality, the pooled mortality rate among AKI patients was 19.70% (95% CI: 10.45%–30.72%; I² = 88.6%). Subgroup analyses showed variability by region, AKI definition, and diagnostic method. Major publication bias was identified for mortality outcomes (LFK = 4.17), but not for AKI prevalence (LFK = -0.13). Conclusion: AKI is a frequent and severe complication of scrub typhus, with high associated mortality. Early diagnosis and effective management are crucial, particularly in endemic regions with limited healthcare resources. Standardized diagnostic criteria and further research on long-term renal outcomes are essential to improving patient care.