Prognostic value of Cardiac Biomarkers in COVID-19 Infection: A Meta-analysis

Abstract

BackgroundMultiple Biomarkers have recently been shown to be elevated in COVID-19, a respiratory infection with multi-organ dysfunction; however, information regarding the prognostic value of cardiac biomarkers as it relates to disease severity and cardiac injury are inconsistent.Research QuestionThe goal of this meta-analysis was to summarize the evidence regarding the prognostic relevance of cardiac biomarkers from data available in published reports.Study Design and MethodsPubMed was searched from inception through April 2020 for studies comparing median values of cardiac biomarkers in critically ill versus non-critically ill COVID-19 patients, or patients who died versus those who survived. The weighted mean differences (WMD) and 95% confidence interval (CI) between the groups were calculated for each study and combined using a random effects meta-analysis model. The odds ratio (OR) for mortality based on cardiac injury was combined from studies reporting it.ResultsTroponin levels were significantly higher in COVID-19 patients who died or were critically ill versus those who were alive or not critically ill (WMD 0.58, 95% CI 0.42-0.71, p<0.001). Cardiac injury was independently associated with significantly increased odds of mortality (OR 6.641, 95% CI 1.26 - 35.1, p=0.03). No difference in BNP was seen between the two groups. A significant difference in levels of D-dimer was seen in those who died or were critically ill. CK levels were only significantly higher in those who died versus those who were alive (WMD 0.47 95% CI 0.09-0.84, p=0.014).InterpretationCardiac biomarkers add prognostic value to the determination of the severity of COVID-19 and can predict mortality.

Weight loss, malnutrition, and cachexia in COVID‐19: facts and numbers

“…Weight loss in COVID‐19 patients has been found to positively correlate with higher CRP levels, reduced kidney function, and longer duration of disease 6 . Possible associations likely also include abnormal markers of cardiac and kidney function in COVID‐19, 31,32 as cachexia in acute and in chronic COVID‐19 disease may also develop as a secondary consequence of cardiac and renal problems. Therapies that prevent cardiac and renal events may therefore also be useful in the short‐term and long‐term care of patients with COVID‐19 or after COVID‐19 acute illness.…”

Early Diagnosis and Clinical Significance of Acute Cardiac Injury - Under the Iceberg: A Retrospective Cohort Study of 619 Non-critically Ill Hospitalized COVID-19 Pneumonia Patients

“…A presentation on the current worldwide pandemic caused by COVID-19 was given by 23 . Considering the above conclusion, we believe early diagnosis and treatment will be much important to improve the prognosis of ACI patients with COVID-19.…”

“…Furthermore, a meta-analysis including 1664 patients illustrated that ACI could occur in one third of patients with COVID-19 22 . More than one studies have demonstrated that Cardiac injury was independently associated with significantly increase of mortality 22, 23 . Considering the above conclusion, we believe early diagnosis and treatment will be much important to improve the prognosis of ACI patients with COVID-19.…”

The prognostic role of cardiac troponin in hospitalized COVID-19 patients

“…Early reports from China suggest that cTn values > 99 th percentile of the upper normal limit (ULN) are powerful predictors of poor outcomes and mortality in COVID-19 patients 5 , 6 , 13 . However, a recent meta-analysis of studies comparing cTn levels in patients who were critically ill to those who were not demonstrated no significant differences between cTn levels 14 . Finally, the impact of elevated cTn on the outcomes in COVID-19 patients is not well studied and characterized 15 , 16 , 17 , 18 , 19 , 20 .…”