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Meta-Analysis
. 2021 Jan 4;31(1):2-13.
doi: 10.1016/j.numecd.2020.09.004. Epub 2020 Sep 11.

Prevalence and clinical outcomes of cardiac injury in patients with COVID-19: A systematic review and meta-analysis

Zhen Huang  1 , Pan Huang  2 , Binbin Du  1 , Lingyao Kong  1 , Wenyuan Zhang  1 , Yanzhou Zhang  1 , Jianzeng Dong  3
Affiliations
Meta-Analysis

Prevalence and clinical outcomes of cardiac injury in patients with COVID-19: A systematic review and meta-analysis

Zhen Huang et al. Nutr Metab Cardiovasc Dis. .

Abstract

Background and aims: Emerging data have linked the presence of cardiac injury with a worse prognosis in novel coronavirus disease 2019 (COVID-19) patients. However, available data cannot clearly characterize the correlation between cardiac injury and COVID-19. Thus, we conducted a meta-analysis of recent studies to 1) explore the prevalence of cardiac injury in different types of COVID-19 patients and 2) evaluate the association between cardiac injury and worse prognosis (severe disease, admission to ICU, and mortality) in patients with COVID-19.

Methods and results: Literature search was conducted through PubMed, the Cochrane Library, Embase, and MedRxiv databases. A meta-analysis was performed with Stata 14.0. A fixed-effects model was used if the I2 values ≤ 50%, otherwise the random-effects model was performed. The prevalence of cardiac injury was 19% (95% CI: 0.15-0.22, and p < 0.001) in total COVID-19 patients, 36% (95% CI: 0.25-0.47, and p < 0.001) in severe COVID-19 patients, and 48% (95% CI: 0.30-0.66, and p < 0.001) in non-survivors. Furthermore, cardiac injury was found to be associated with a significant increase in the risk of poor outcomes with a pooled effect size (ES) of 8.46 (95% CI: 3.76-19.06, and p = 0.062), severe disease with an ES of 3.54 (95% CI: 2.25-5.58, and p < 0.001), admission to ICU with an ES of 5.03 (95% CI: 2.69-9.39, and p < 0.001), and mortality with an ES of 4.99 (95% CI: 3.38-7.37, and p < 0.001).

Conclusions: The prevalence of cardiac injury was greatly increased in COVID-19 patients, particularly in patients with severe disease and non-survivors. COVID-19 patients with cardiac injury are more likely to be associated with poor outcomes, severity of disease, admission to ICU, and mortality.

Keywords: COVID-19; Cardiac injury; Outcome; Prevalence; SARS-CoV-2.

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Figures

Figure 1
Figure 1
Flow diagram for study selection.
Figure 2
Figure 2
Forest plot showing prevalence cardiac injury in total patients.
Figure 3
Figure 3
Forest plot showing prevalence cardiac injury in severe patients.
Figure 4
Figure 4
Forest plot showing prevalence cardiac injury in non-survivors.
Figure 5
Figure 5
Forest plot for association between cardiac injuries and mortality.
See this image and copyright information in PMC

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