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?:abstract
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Current evidence is limited to small studies describing the association between cardiac injury and outcomes in patients with 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 (ARDS), acute kidney injury (AKI) and coagulopathy. Further, studies comparing cardiac biomarker levels in survivors versus non-survivors were included. A total of 14 studies (3175 patients) were utilized for the final analysis. Cardiac injury in patients with COVID-19 was associated with higher risk of mortality [RR:7.79; 95%CI: 4.69-13.01; I(2)=58%], ICU admission [RR: 4.06; 95%CI: 1.50-10.97; I(2)=61%], mechanical ventilation [RR: 5.53; 95%CI: 3.09-9.91; I(2)=0%], and developing coagulopathy [RR: 3.86; 95%CI:2.81-5.32; I(2)=0%]. However, cardiac injury was not associated with increased risk of ARDS [RR:3.22; 95%CI:0.72-14.47; I(2)=73%] or AKI [RR: 11.52, 95%CI:0.03-4159.80; I(2)=0%]. The levels of hs-cTnI [MD:34.54 pg/ml;95%CI: 24.67- 44.40 pg/ml; I(2)=88%], myoglobin [MD:186.81 ng/ml;95% CI: 121.52-252.10 ng/ml; I(2)=88%], NT-pro BNP [MD:1183.55 pg/ml; 95% CI: 520.19-1846.91 pg/ml: I(2)=96%] and CK-MB [MD:2.49 ng/ml;95% CI: 1.86-3.12 ng/ml; I(2)=90%] were significantly elevated in non-survivors 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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