Key result
Fatal COVID-19 is linked to ~7-fold higher risk of acute cardiac injury vs. survivors.
Why the study?
The study was conducted to explore the correlation between cardiac-related comorbidities, cardiac biomarkers, acute myocardial injury, and severity level and outcomes in COVID-19 patients.
Are acute cardiac injury and elevated cardiac biomarkers associated with increased severity and mortality in patients with COVID-19?
Meta-Analysis (n=15,354)
Yes
Are acute cardiac injury and elevated cardiac biomarkers associated with increased severity and mortality in patients with COVID-19?
Acute cardiac injury and elevated cardiovascular biomarkers are strongly associated with severe illness and mortality in patients with COVID-19.
Answers are grounded in this paper and cite their sources.
Acute cardiac injury identifies high-mortality COVID-19 risk; confirms observational link but leaves interventional benefit open for trials.
Aims To explore the correlation between cardiac‐related comorbidities, cardiac biomarkers, acute myocardial injury, and severity level, outcomes in COVID‐19 patients. Method Pubmed, Web of Science, Embase, CNKI, VIP, Wanfang, Cochrane Library databases, medRxiv, and Sinomed were reviewed systemically. Various types of clinical research reporting cardiac‐related comorbidities, cardiac biomarkers including lactate dehydrogenase (LDH), troponin I (TnI), high sensitivity troponin I (hs‐TnI), creatine kinase (CK), creatine kinase–MB (CK‐MB), myoglobin (Myo), N‐terminal pro‐b‐type natriuretic peptide (NT‐proBNP) and acute cardiac injury grouped by severity of COVID‐19 were included. Outcome measures were events and total sample size for comorbidities, acute cardiac injury, and laboratory parameters of these biomarkers. The study was performed with Stata version 15.1. Results Seventy studies, with a total of 15,354 cases were identified. The results showed that COVID‐19's severity was related to cardiovascular disease. Similar odds ratios (ORs) were achieved in hypertension except for severe versus critical group (OR = 1.406; 95% CI, 0.942–2.097; p = .095). The relative risk (RR) of acute cardiac injury is 7.01 (95% CI, 5.64–8.71) in non‐survivor cases. When compared with the different severity of cardiac biomarkers, the pool OR of CK, CK‐MB, TnI, Myo and LDH were 2.683 (95% CI, 0.83–8.671; p = .106; I 2 = 0%), 2.263 (95% CI, 0.939–5.457; p = .069), 1.242 (95% CI, 0.628–2.457; p = .534), 1.756 (95% CI, 0.608–5.071; p = .298; I 2 = 42.3%), 1.387 (95% CI, 0.707–2.721; p = .341; I 2 = 0%) in the critical versus severe group, whose trends were not similar to other groups. The standard mean differences (SMD) of CK and TnI in the critical versus severe group were 0.09 (95% CI, −0.33 to 0.50; p = .685; I 2 = 65.2%), 0.478 (95% CI, −0.183 to 1.138; p = .156; I 2 = 76.7%), which means no difference was observed in the serum level of these indicators. Conclusion Most of the findings clearly indicate that hypertension, cardiovascular disease, acute cardiac injury, and related laboratory indicators are associated with the severity of COVID‐19. What is now needed are cross‐national prospectively designed observational or clinical trials that will help improve the certainty of the available evidence and treatment decisions for patients.
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Zhu et al. (2021) conducted a meta-analysis in COVID-19 (n=15,354). Fatal COVID-19 (Non-survival) vs. COVID-19 Survival was evaluated on Acute cardiac injury (RR 7.01, 95% CI 5.64-8.71, p=<0.001). Fatal COVID-19 was associated with a markedly increased risk of acute cardiac injury compared to surviving COVID-19 patients (RR 7.01, 95% CI 5.64-8.71).
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