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Meta-Analysis
. 2021 Jun:44:352-357.
doi: 10.1016/j.ajem.2020.04.052. Epub 2020 Apr 19.

Cardiac injury is associated with mortality and critically ill pneumonia in COVID-19: A meta-analysis

Anwar Santoso  1 , Raymond Pranata  2 , Arief Wibowo  3 , Makhyan Jibril Al-Farabi  4 , Ian Huang  2 , Budhi Antariksa  5
Affiliations
Meta-Analysis

Cardiac injury is associated with mortality and critically ill pneumonia in COVID-19: A meta-analysis

Anwar Santoso et al. Am J Emerg Med. 2021 Jun.

Abstract

Background: In this systematic review and meta-analysis, we aimed to explore the association between cardiac injury and mortality, the need for intensive care unit (ICU) care, acute respiratory distress syndrome (ARDS), and severe coronavirus disease 2019 (COVID-19) in patients with COVID-19 pneumonia.

Methods: We performed a comprehensive literature search from several databases. Definition of cardiac injury follows that of the included studies, which includes highly sensitive cardiac troponin I (hs-cTnl) >99th percentile.The primary outcome was mortality, and the secondary outcomes were ARDS, the need for ICU care, and severe COVID-19. ARDS and severe COVID-19 were defined per the World Health Organization (WHO) interim guidance of severe acute respiratory infection (SARI) of COVID-19.

Results: There were a total of 2389 patients from 13 studies. This meta-analysis showed that cardiac injury was associated with higher mortality (RR 7.95 [5.12, 12.34], p < 0.001; I2: 65%). Cardiac injury was associated with higher need for ICU care (RR 7.94 [1.51, 41.78], p = 0.01; I2: 79%), and severe COVID-19 (RR 13.81 [5.52, 34.52], p < 0.001; I2: 0%). The cardiac injury was not significant for increased risk of ARDS (RR 2.57 [0.96, 6.85], p = 0.06; I2: 84%). The level of hs-cTnI was higher in patients with primary + secondary outcome (mean difference 10.38 pg/mL [4.44, 16.32], p = 0.002; I2: 0%).

Conclusion: Cardiac injury is associated with mortality, need for ICU care, and severity of disease in patients with COVID-19.

Keywords: COVID-19; Cardiac injury; Coronavirus; Mortality; Troponin.

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Figures

Fig. 1
Fig. 1
PRISMA study flow diagram.
Fig. 2
Fig. 2
Cardiac injury and mortality. Cardiac injury was associated with increased mortality.
Fig. 3
Fig. 3
Cardiac injury and secondary outcome. Cardiac injury was associated with an increased need for ICU care and severe COVID-19. The association was not significant for ARDS. ARDS: Acute Respiratory Distress Syndrome, ICU: Intensive Care Unit.
Fig. 4
Fig. 4
Highly-sensitive troponin I and primary + secondary outcome. Elevated hs-cTnI was associated with poor outcome. hs-cTnI: Highly-sensitive Troponin I.
Fig. 5
Fig. 5
Funnel-plot analysis. Funnel-plot analysis showing asymmetrical funnel plot for mortality.
See this image and copyright information in PMC

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References

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