Cardiac biomarkers, cardiac injury, and comorbidities associated with severe illness and mortality in coronavirus disease 2019 (COVID‐19): A systematic review and meta‐analysis

Abstract

Aims To explore the correlation between cardiac‐related comorbidities, cardiac biomarkers, acute myocardial injury, and severity level, outcomes in COVID‐19 patients. Method Pubmed, Web of Science, Embase, CNKI, VIP, Wanfang, Cochrane Library databases, medRxiv, and Sinomed were reviewed systemically. Various types of clinical research reporting cardiac‐related comorbidities, cardiac biomarkers including lactate dehydrogenase (LDH), troponin I (TnI), high sensitivity troponin I (hs‐TnI), creatine kinase (CK), creatine kinase–MB (CK‐MB), myoglobin (Myo), N‐terminal pro‐b‐type natriuretic peptide (NT‐proBNP) and acute cardiac injury grouped by severity of COVID‐19 were included. Outcome measures were events and total sample size for comorbidities, acute cardiac injury, and laboratory parameters of these biomarkers. The study was performed with Stata version 15.1. Results Seventy studies, with a total of 15,354 cases were identified. The results showed that COVID‐19's severity was related to cardiovascular disease. Similar odds ratios (ORs) were achieved in hypertension except for severe versus critical group (OR = 1.406; 95% CI, 0.942–2.097; p = .095). The relative risk (RR) of acute cardiac injury is 7.01 (95% CI, 5.64–8.71) in non‐survivor cases. When compared with the different severity of cardiac biomarkers, the pool OR of CK, CK‐MB, TnI, Myo and LDH were 2.683 (95% CI, 0.83–8.671; p = .106; I 2 = 0%), 2.263 (95% CI, 0.939–5.457; p = .069), 1.242 (95% CI, 0.628–2.457; p = .534), 1.756 (95% CI, 0.608–5.071; p = .298; I 2 = 42.3%), 1.387 (95% CI, 0.707–2.721; p = .341; I 2 = 0%) in the critical versus severe group, whose trends were not similar to other groups. The standard mean differences (SMD) of CK and TnI in the critical versus severe group were 0.09 (95% CI, −0.33 to 0.50; p = .685; I 2 = 65.2%), 0.478 (95% CI, −0.183 to 1.138; p = .156; I 2 = 76.7%), which means no difference was observed in the serum level of these indicators. Conclusion Most of the findings clearly indicate that hypertension, cardiovascular disease, acute cardiac injury, and related laboratory indicators are associated with the severity of COVID‐19. What is now needed are cross‐national prospectively designed observational or clinical trials that will help improve the certainty of the available evidence and treatment decisions for patients.

Physiological Network Is Disrupted in Severe COVID-19

“…Particularly, we found that several inflammatory, thrombotic, and hepatic biomarkers change their behavior in COVID-19. In agreement with current knowledge (Supplementary Table 4), well-known cardiovascular biomarkers such as ultrasensitive troponin (Zhu et al, 2021), C-reactive protein, and lactic dehydrogenase were increased in the groups with fatal outcome (Supplementary Table 4). Our work reinforces the role of other less well identified biomarkers such as hepatic features (Ramos-Lopez et al, 2021) and pulmonary artery diameters (Spagnolo et al, 2020).…”

Laboratory Biomarkers for Diagnosis and Prognosis in COVID-19

“…Cardiovascular manifestations of COVID-19 are frequently reported ( 2 , 40 ). Acute heart failure and exacerbation of chronic heart failure are reported in up to 20-30% of hospitalized patients, and carry high mortality rates, especially in patients with severe comorbidities ( 41 – 43 ). Acute coronary syndrome has been reported in a high proportion of patients, probably because of plaque rupture, coronary spasm, or microthrombi triggered by systemic inflammation and cytokine storm ( 44 ).…”

Biomarkers Associated with Cardiovascular Disease in COVID-19

“…The prognostic value of hs-cTn in COVID-19 has been consistently shown in multiple, different study populations across the globe and was confirmed by data from several metaanalyses [39][40][41][42]. One of the more recent ones reported a significant association between COVID-19 disease severity and levels of cardiac troponin from pooled patient data of 28 studies comprising 7812 cases.…”