Cardiac troponins predict mortality in patients with COVID-19: A meta-analysis of adjusted risk estimates

Vrsalović, Mislav; Presečki, Ana Vrsalović

doi:10.1016/j.jinf.2020.05.022

Cited by 33 publications

(40 citation statements)

References 10 publications

(15 reference statements)

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“…Similar to findings in patients with other severe respiratory illnesses, elevated troponins appeared to have prognostic implications for patients admitted for covid-19. Some recent systematic reviews and meta-analyses have reported on the associations between elevated troponins and adverse outcomes of covid-19 [ 5 – 8 , 79 , 80 ]. However, there are several limitations to these analyses, including not accounting for the time point of troponin measurements and the cut-off threshold for troponin elevation, the variability in outcome definitions, the lack of adjustment for confounders and the inclusion of overlapping cohorts in analysis.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and prognostic value of elevated troponins in patients hospitalised for coronavirus disease 2019: a systematic review and meta-analysis

et al. 2020

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Background The clinical significance of cardiac troponin measurement in patients hospitalised for coronavirus disease 2019 (covid-19) is uncertain. We investigated the prevalence of elevated troponins in these patients and its prognostic value for predicting mortality. Methods Studies were identified by searching electronic databases and preprint servers. We included studies of hospitalised covid-19 patients that reported the frequency of troponin elevations above the upper reference limit and/or the association between troponins and mortality. Meta-analyses were performed using random-effects models. Results Fifty-one studies were included. Elevated troponins were found in 20.8% (95% confidence interval [CI] 16.8–25.0 %) of patients who received troponin test on hospital admission. Elevated troponins on admission were associated with a higher risk of subsequent death (risk ratio 2.68, 95% CI 2.08–3.46) after adjusting for confounders in multivariable analysis. The pooled sensitivity of elevated admission troponins for predicting death was 0.60 (95% CI 0.54–0.65), and the specificity was 0.83 (0.77–0.88). The post-test probability of death was about 42% for patients with elevated admission troponins and was about 9% for those with non-elevated troponins on admission. There was significant heterogeneity in the analyses, and many included studies were at risk of bias due to the lack of systematic troponin measurement and inadequate follow-up. Conclusion Elevated troponins were relatively common in patients hospitalised for covid-19. Troponin measurement on admission might help in risk stratification, especially in identifying patients at high risk of death when troponin levels are elevated. High-quality prospective studies are needed to validate these findings. Systematic review registration PROSPERO CRD42020176747

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Section: Discussionmentioning

confidence: 99%

Prevalence and prognostic value of elevated troponins in patients hospitalised for coronavirus disease 2019: a systematic review and meta-analysis

et al. 2020

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“…Elevated troponins, indicating cardiac damage, are common findings during the pandemic [18]. These raised troponins are also a predictor of mortality [19]. The cardiomyopathy seems to be an immune or hormone-driven pathology rather than due to direct invasion of the SARS-CoV-2 virion in the myocardium [20].…”

Section: Introductionmentioning

confidence: 99%

Thrombosis in Coronavirus disease 2019 (COVID-19) through the prism of Virchow’s triad

2020

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The pathogenesis of Coronavirus disease 2019 (COVID-19) is gradually being comprehended. A high number of thrombotic episodes are reported, along with the mortality benefits of heparin. COVID-19 can be viewed as a prothrombotic disease. We overviewed the available evidence to explore this possibility. We identified various histopathology reports and clinical case series reporting thromboses in COVID-19. Also, multiple coagulation markers support this. COVID-19 can be regarded as a risk factor for thrombosis. Applying the principles of Virchow's triad, we described abnormalities in the vascular endothelium, altered blood flow, and platelet function abnormalities that lead to venous and arterial thromboses in COVID-19. Endothelial dysfunction, activation of the renin-angiotensin-aldosterone system (RAAS) with the release of procoagulant plasminogen activator inhibitor (PAI-1), and hyperimmune response with activated platelets seem to be significant contributors to thrombogenesis in COVID-19. Stratifying risk of COVID-19 thromboses should be based on age, presence of comorbidities, D-dimer, CT scoring, and various blood cell ratios. Isolated heparin therapy may not be sufficient to combat thrombosis in this disease. There is an urgent need to explore newer avenues like activated protein C, PAI-1 antagonists, and tissue plasminogen activators (tPA). These should be augmented with therapies targeting RAAS, antiplatelet drugs, repurposed antiinflammatory, and antirheumatic drugs.

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“…Vrsalovic et al [13] used troponin to predict the death of COVID-19 patients. There are also some literatures that comprehensively analyzed multiple influencing factors, but there were only Chinese patients in these literatures, which caused a certain degree of one-sidedness.…”

Section: Introductionmentioning

confidence: 99%

The impact of vital signs on the death of patients with new coronavirus pneumonia: A systematic review and meta-analysis

Zhao

Yin

et al. 2020

Preprint

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Background: Assessing the impact of vital signs (blood pressure, body temperature, heart rate, respiratory rate, and oxygen saturation) on the death of patients with new coronavirus pneumonia would provide a simple and convenient method for the monitoring of subsequent illness, and therefore, in some degree reduce treatment costs and increase the cure rate clinically. Methods: Six databases were retrieved. The software R 3.6.2 was used for meta-analysis of the included literature. Results: 12 studies were included, which comprise 8996 patients affected with COVID-19 infection. The meta-analysis study found that blood pressure (MAP, SBP and DBP), heart rate, respiration rate and SpO2 are the risk factors for disease progression in patients with COVID-19. Among them, the increase in MAP and the decrease in SpO2 have the greatest impact on the death of patients with COVID-19 [MAP: MD = 5.66, 95% CI (0.34, 10.98), SpO2: MD = -5.87, 95% CI (-9.17, -2.57), P = 0.0005]. However, comparing the body temperature of the death group and the survival group found that the body temperature was not statistically significant between the two groups [body temperature: MD = 0.21, 95% CI (-0.01, 0.43), P = 0.0661]. Conclusion: The increase in MAP, heart rate and respiratory rate, as well as the decrease in SBP, DBP and SpO2 are all independent risk factors for death in patients with COVID-19. These factors are simple and easy to monitor, and individualized treatment can be given to patients in time, reducing the mortality rate and improving treatment efficiency.

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Cardiac troponins predict mortality in patients with COVID-19: A meta-analysis of adjusted risk estimates

Cited by 33 publications

References 10 publications

Prevalence and prognostic value of elevated troponins in patients hospitalised for coronavirus disease 2019: a systematic review and meta-analysis

Prevalence and prognostic value of elevated troponins in patients hospitalised for coronavirus disease 2019: a systematic review and meta-analysis

Thrombosis in Coronavirus disease 2019 (COVID-19) through the prism of Virchow’s triad

The impact of vital signs on the death of patients with new coronavirus pneumonia: A systematic review and meta-analysis

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