Background: This systematic review and meta-analysis aimed to assess whether low serum 25-hydroxyvitamin D (25-OHD) level is associated with susceptibility to COVID-19, severity, and mortality related to COVID-19.Methods: Systematic literature searches of PubMed, Scopus, and Embase database up until 9 December 2020. We include published observational prospective and retrospective studies with information on 25-OHD that reported main/secondary outcome. Low serum 25-OHD refers to participants with serum 25-OHD level below a cut-off point ranging from 20 to 30 ng/mL. Other cut-off values were excluded to reduce heterogeneity. The main outcome was mortality defined as non-survivor/death. The secondary outcome was susceptibility and severe COVID-19.Results: There were 14 studies comprising of 999,179 participants. Low serum 25-OHD was associated with higher rate of COVID-19 infection compared to the control group (OR = 2.71 [1.72, 4.29], p < 0.001; I2: 92.6%). Higher rate of severe COVID-19 was observed in patients with low serum 25-OHD (OR = 1.90 [1.24, 2.93], p = 0.003; I2: 55.3%), with a sensitivity of 83%, specificity of 39%, PLR of 1.4, NLR of 0.43, and DOR of 3. Low serum 25-OHD was associated with higher mortality (OR = 3.08 [1.35, 7.00], p = 0.011; I2: 80.3%), with a sensitivity of 85%, specificity of 35%, PLR of 1.3, NLR of 0.44, and DOR of 3. Meta-regression analysis showed that the association between low serum 25-OHD and mortality was affected by male gender (OR = 1.22 [1.08, 1.39], p = 0.002), diabetes (OR = 0.88 [0.79, 0.98], p = 0.019).Conclusion: Low serum 25-OHD level was associated with COVID-19 infection, severe presentation, and mortality.

Background This systematic review and meta-analysis aimed to assess whether ventricular longitudinal strain can be used as a prognostication tool in patients with coronavirus disease 2019 (COVID-19). Methods Systematic literature searches of PubMed, Embase, and EuropePMC databases were performed on 16 November 2020. Left ventricular global longitudinal strain (LV-GLS) refers to LV contraction measurement using the speckle tracking-based method refers to the mean of strain values of the RV free wall (three segments) measured using echocardiography. The main outcome was poor outcome, defined as a composite of mortality and severe COVID-19. Results Seven studies comprising of 612 patients were included in meta-analysis. Six studies have mortality as their outcome, and 1 study has severity as their outcome. Patients with poor outcome have lower LV-GLS (SMD 1.15 (0.57, 1.72), p < 0.001; I2 70.4%). Each 1% decrease in LV-GLS was associated with 1.4x increased risk of poor outcome (OR 1.37 (1.12, 1.67), p = 0.002; I2 48.8%). Patients with poor outcome have lower RV-LS (SMD 1.18 (0.91, 1.45), p < 0.001; I2 0%). Each 1% decrease in RV-LS was associated with 1.3x increased risk of poor outcome (OR 1.25 (1.15, 1.35), p < 0.001; I2 11.8%). Subgroup analysis showed that for every 1% decrease in LV-GLS and RV-LS is increased mortality with OR of 1.30 (1.12, 1.50) and OR of 1.24 (1.14, 1.35), respectively. Conclusion This study shows that lower LV-GLS and RV-LS measurements were associated with poor outcome in patients with COVID-19. Trial registration PROSPERO CRD42020221144

Background Cardiac injury is frequently encountered in patients with COVID-19 and is associated with an increased risk of mortality. Elevated troponin may signify myocardial damage and predicts mortality. We aimed to assess the prognostic value of elevated troponin above the 99 th percentile upper reference limit (URL) on mortality and factors affecting their relationship. Methods We performed a comprehensive literature search using PubMed (MEDLINE), Scopus, and Embase from inception of the search databases until 16 th December 2020. The key exposure was elevated serum troponin, defined as troponin (of any type) elevation > 99th percentile URL. The outcome was mortality due to any causes. Results There were a total of 12,262 patients from 13 studies in this systematic review and meta-analysis. Mortality was present in 23% (20-26%) of the patients. Elevated troponin was present in 31% (23-38%) of the patients. Elevated troponin was associated with increased mortality (OR 4.75 [4.07, 5.53], p < 0.001; I 2 : 19.9%). Meta-regression shows that the association did not vary with age (p = 0.218), male gender (p = 0.707), hypertension (p = 0.182), diabetes (p = 0.906), and coronary artery disease (p = 0864). Elevated troponin was associated with sensitivity of 0.55 [0.44, 0.66], specificity of 0.80 [0.71, 0.86], PLR 2.7 of [2.2, 3.3], NLR of 0.56 [0.49, 0.65], DOR of 5 [4, 5], and AUC of 0.73 [0.69, 0.77]. Elevated troponin resulted in a 45% probability for mortality and non-elevated troponin resulted in a 14% probability for mortality. Conclusion Elevated troponin was associated with increased mortality with a 55% sensitivity and 80% specificity.