The effect of cardiovascular disease and acute cardiac injury on fatal COVID-19: a meta-analysis

Long, Jiali; Luo, Y F; Wei, Yuehong; Xie, Chunguang; Yuan, Jun

doi:10.1016/j.ajem.2021.04.013

Cited by 14 publications

(17 citation statements)

References 65 publications

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“…It was found that an acute cardiac injury occurred in a significant number of COVID19 patients, leading to increased admission to the intensive care unit and higher mortality (Momtazmanesh et al, 2020;Vakhshoori et al, 2020b;Li et al, 2020a). Recently, Long et al (Long et al, 2021) evaluated by meta-analysis the mortality risks associated with cardiovascular disease (CVD) and cardiac injury in hospitalized COVID19 patients in populations from four different countries and found that hospitalized COVID19 patients with cardiovascular events were at a higher risk of fatal outcomes than those without CVD (Shoar et al, 2020;Long et al, 2021).…”

Section: Cardiac Injurymentioning

confidence: 99%

COVID19 biomarkers: What did we learn from systematic reviews?

Semiz

2022

Front. Cell. Infect. Microbiol.

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The coronavirus disease 2019 (COVID19) pandemic continues to represent a substantial public health concern. It can rapidly progress to severe disease, with poor prognosis and a high mortality risk. An early diagnosis and specific prognostic tools can help healthcare providers to start interventions promptly, understand the likely prognosis and to identify and treat timely individuals likely to develop severe disease with enhanced mortality risk. Here we focused on an impressive set of systematic reviews and meta-analyses that were performed since the start of the COVID19 pandemic and summarized their results related to the levels of hematologic, inflammatory, immunologic biomarkers as well as markers of cardiac, respiratory, hepatic, gastrointestinal and renal systems and their association with the disease progression, severity and mortality. The evidence outlines the significance of specific biomarkers, including inflammatory and immunological parameters (C-reactive protein, procalcitonin, interleukin-6), hematological (lymphocytes count, neutrophil-to-lymphocyte ratio, D-dimer, ferritin, red blood cell distribution width), cardiac (troponin, CK-MB, myoglobin), liver (AST, ALT, total bilirubin, albumin) and lung injury (Krebs von den Lungen-6) that can be used as prognostic biomarkers to aid the identification of high-risk patients and the prediction of serious outcomes, including mortality, in COVID19. Thus, these parameters should be used as essential tools for an early risk stratification and adequate intervention in improving disease outcomes in COVID19 patients.

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Section: Cardiac Injurymentioning

confidence: 99%

COVID19 biomarkers: What did we learn from systematic reviews?

Semiz

2022

Front. Cell. Infect. Microbiol.

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“…The majority of studies (46 studies) reported the impact of CI on mortality (Table 1) [5,12,15,17,18,20,[22][23][24]29,[31][32][33]35,39,40,[42][43][44][45][46][47][48][49][50][51][52][53][56][57][58][59][60][61][62][63][64][65][66][67]70,73,74,[76][77][78].…”

Section: Resultsmentioning

confidence: 99%

Cardiac Injury in COVID-19: A Systematic Review of Relevant Meta-Analyses

Kyriakoulis¹,

Kyriakoulis²,

Trontzas³

et al. 2022

Rev. Cardiovasc. Med.

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Background: Cardiac injury (CI) is not a rare condition among hospitalized patients with coronavirus disease 2019 . Its prognostic value has been extensively reported through the literature, mainly in the context of observational studies. An impressive number of relevant meta-analyses has been conducted. These meta-analyses present similar and consistent results; yet interesting methodological issues emerge. Methods: A systematic literature search was conducted aiming to identify all relevant meta-analyses on (i) the incidence, and (ii) the prognostic value of CI among hospitalized patients with COVID-19. Results: Among 118 articles initially retrieved, 73 fulfilled the inclusion criteria and were included in the systematic review. Various criteria were used for CI definition mainly based on elevated cardiac biomarkers levels. The most frequently used biomarker was troponin. 30 meta-analyses reported the pooled incidence of CI in hospitalized patients with COVID-19 that varies from 5% to 37%. 32 meta-analyses reported on the association of CI with COVID-19 infection severity, with only 6 of them failing to show a statistically significant association. Finally, 46 meta-analyses investigated the association of CI with mortality and showed that patients with COVID-19 with CI had increased risk for worse prognosis. Four meta-analyses reported pooled adjusted hazard ratios for death in patients with COVID-19 and CI vs those without CI ranging from 1.5 to 3. Conclusions: The impact of CI on the prognosis of hospitalized patients with COVID-19 has gained great interest during the pandemic. Methodological issues such as the inclusion of not peer-reviewed studies, the inclusion of potentially overlapping populations or the inclusion of studies with unadjusted analyses for confounders should be taken into consideration. Despite these limitations, the adverse prognosis of patients with COVID-19 and CI has been consistently demonstrated.

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“…Checking troponin levels was useful among older individuals regardless of their cardiac-related comorbidities [17]. Increased length of hospital stay (median days, 5 [3][4][5][6][7][8][9] vs. 4 [2][3][4][5][6][7]) and ICU admission (46.2% vs. 31.4%) occurred more frequently in the myocardial-injury group. Based on these findings, for every 100 hospitalized patients, patients with higher troponin levels would be anticipated to result in 15 additional ICU admissions until hospital discharge with an overall increased length of stay.…”

Section: Discussionmentioning

confidence: 99%

“…The length of hospital stay, ICU admission rates, and in-hospital mortality were higher among myocardial-injury patients than no-myocardial-injury patients according to the univariate analyses (median length of stay, 5 (3)(4)(5)(6)(7)(8)(9) days for the myocardial-injury group and 4 (2-7) days for the no-myocardial-injury group; ICU admission, 46.2% vs. 31.4%; mortality, 22.8% vs. 11.6%; Table 3). The survival analysis showed a clear difference in the Kaplan-Meier plot based on the univariate analysis (Figure 1 shows the survival analysis results stratified by myocardial injury based on the univariate analysis).…”

Section: Outcome Measuresmentioning

confidence: 97%

“…A varying degree of cardiac injuries were noted in patients diagnosed with COVID-19. It was speculated that patients with previously known cardiac diseases or risk factors had a higher prevalence of cardiac injury compared to patients without cardiac disease; nevertheless, myocardial injury among patients without pre-existing cardiac conditions had worse outcomes overall [7]. Wei et al identified multiple mechanisms of myocardial injury in COVID-19, including the direct virulence of SARS-CoV-2 through ACE-2, exaggerated inflammatory reaction, micro thrombosis and endothelial injury, and hypoxic cardiac injury [8,9].…”

Section: Introductionmentioning

confidence: 99%

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Prevalence, Predictors, and Outcomes of Myocardial Injury in Hospitalized COVID-19 Patients—An Observational Retrospective Study

Patel

Smith²,

Baloch³

et al. 2022

Hearts

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COVID-19 mainly causes pulmonary manifestation; nonetheless, its systemic inflammatory response involves multiple organs, including the heart. We aimed to evaluate the prevalence, predictors, and outcomes of myocardial injury in hospitalized patients with SARS-CoV-2 infection. Methods and Results: We performed an observational retrospective analysis on patients hospitalized with COVID-19 in a moderate-sized community hospital system. Myocardial injury was defined as highly sensitive troponin T levels in the 99th percentile above the normal upper limit for the respective biological sex. Multivariable logistic regression models were fitted to assess the association between the myocardial-injury and the no-myocardial-injury groups for primary and secondary outcomes. A total of 1632 (49.3% male, 41.7% aged 60–79 years) patients with COVID-19 were included, out of which 312 (19.1%) had a myocardial injury. Patients with myocardial injury were older (36.9% > 80 years) and had higher cardiovascular-related comorbidities than those without. The prevalence of cardiovascular risk factors (78.5% vs. 52.0%) and cardiovascular diseases (78.2% vs. 56.1%) was much higher in the myocardial-injury group. Older age (50–64 years vs. <49 years; OR, 3.67 [1.99–6.74]), Angiotensin Receptor Blockers (ARBs) (OR, 1.44 [1.01–2.05]), Beta-blockers (OR, 2.37 [1.80–3.13]), and cardiovascular comorbidities (OR, 1.49 [1.09–2.05]) were strong predictors of cardiac injury after multivariable adjustment. Myocardial injury was strongly associated with ICU admission (adjusted OR, 1.68 [1.29–2.19]) and longer length of hospital stay (median days, 5 (3, 9) vs. 4 (2, 7)). The results do not show a significant difference in the use of mechanical ventilation (OR, 1.29 [0.87–1.89]) or in-hospital mortality (OR, 1.37 [0.98–1.91]) with respect to myocardial injury. Conclusion: This multicenter retrospective study of nearly 1600 patients revealed the following findings: Myocardial injury was observed in 1 out of 5 patients hospitalized with COVID-19 but was more often clinically insignificant. Patients of age > 65 had very high odds of having elevated troponin levels after adjusting for sex and other illnesses. Pre-existing cardiac diseases and risk factors were robust predictors of cardiac injury after adjusting for age and sex. In the adjusted model, myocardial injury was not associated with the requirement of mechanical ventilation or change in in-hospital mortality.

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The effect of cardiovascular disease and acute cardiac injury on fatal COVID-19: a meta-analysis

Cited by 14 publications

References 65 publications

COVID19 biomarkers: What did we learn from systematic reviews?

COVID19 biomarkers: What did we learn from systematic reviews?

Cardiac Injury in COVID-19: A Systematic Review of Relevant Meta-Analyses

Prevalence, Predictors, and Outcomes of Myocardial Injury in Hospitalized COVID-19 Patients—An Observational Retrospective Study

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