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Review
. 2021 Feb 15:141:140-146.
doi: 10.1016/j.amjcard.2020.11.009. Epub 2020 Nov 18.

Meta-analysis Comparing Outcomes in Patients With and Without Cardiac Injury and Coronavirus Disease 2019 (COVID 19)

Agam Bansal  1 , Ashish Kumar  1 , Divyang Patel  1 , Rishi Puri  1 , Ankur Kalra  1 , Samir R Kapadia  1 , Grant W Reed  2
Affiliations
Review

Meta-analysis Comparing Outcomes in Patients With and Without Cardiac Injury and Coronavirus Disease 2019 (COVID 19)

Agam Bansal et al. Am J Cardiol. .

Abstract

Current evidence is limited to small studies describing the association between cardiac injury and outcomes in patients with coronavirus disease 2019 (COVID-19). To address this, we performed a comprehensive meta-analysis of studies in COVID-19 patients to evaluate the association between cardiac injury and all-cause mortality, intensive care unit (ICU) admission, mechanical ventilation, acute respiratory distress syndrome, acute kidney injury and coagulopathy. Further, studies comparing cardiac biomarker levels in survivors versus nonsurvivors were included. A total of 14 studies (3,175 patients) were utilized for the final analysis. Cardiac injury in patients with COVID-19 was associated with higher risk of mortality (risk ratio [RR]:7.79; 95% confidence interval [CI]: 4.69 to 13.01; I2=58%), ICU admission (RR: 4.06; 95% CI: 1.50 to 10.97; I2 = 61%), mechanical ventilation (RR: 5.53; 95% CI: 3.09 to 9.91; I2 = 0%), and developing coagulopathy (RR: 3.86; 95% CI:2.81 to 5.32; I2 = 0%). However, cardiac injury was not associated with increased risk of acute respiratory distress syndrome (RR:3.22; 95% CI:0.72 to 14.47; I2 = 73%) or acute kidney injury (RR: 11.52, 95% CI:0.03 to 4,159.80; I2 = 0%). The levels of hs-cTnI (MD:34.54 pg/ml;95% CI: 24.67 to 44.40 pg/ml; I2 = 88%), myoglobin (MD:186.81 ng/ml; 95% CI: 121.52 to 252.10 ng/ml; I2 = 88%), NT-pro BNP (MD:1183.55 pg/ml; 95% CI: 520.19 to 1846.91 pg/ml: I2 = 96%) and CK-MB (MD:2.49 ng/ml;95% CI: 1.86 to 3.12 ng/ml; I2 = 90%) were significantly elevated in nonsurvivors compared with survivors with COVID-19 infection. The results of this meta-analysis suggest that cardiac injury is associated with higher mortality, ICU admission, mechanical ventilation and coagulopathy in patients with COVID-19.

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Conflict of interest statement

Disclosures The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1
Figure 1
PRISMA diagram describing the selection of studies for our meta-analysis. PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.
Figure 2
Figure 2
Forest plot for all-cause mortality in COVID-19 patients with cardiac injury compared with patients without cardiac injury. CI = confidence interval; RR = risk ratio.
Figure 3
Figure 3
Forest plot for cardiac troponins, myoglobin, NT-pro BNP and CK-MB in non survivors compared with survivors, among COVID-19 infected patients. CI = confidence interval; MD = mean difference.
Figure 4
Figure 4
Forest plot for coagulopathy, acute kidney injury, ICU admission, ARDS and mechanical ventilation in COVID-19 patients with cardiac injury compared with patients without cardiac injury. CI = confidence interval; RR = risk ratio.
Figure 5
Figure 5
Funnel-plot analysis assessing publication bias of studies reporting all-cause mortality in COVID-19 patients with cardiac injury compared with patients without cardiac injury.
See this image and copyright information in PMC

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