Association Between Troponin Elevation and Severity of COVID-19 Infection: A Systematic Review and Meta-Analysis

Abstract

The World Health Organization (WHO) defines severe COVID-19 infection as fever and/or respiratory infection with positive COVID-19 nucleic acid detection plus one of the following: respiratory rate >30 breaths/min; severe respiratory distress; or SpO2 ≤93% on room air. However, there are numerous incidents of cardiac involvement in severe COVID-19. Troponin levels have long been established as a prognostic marker in cardiac injury. Hence, this systematic review aimed to associate raised troponin with disease severity in COVID-19 infection. A systematic literature review of scientific databases was performed to identify relevant published studies between January 2000 and November 2021. 2,551 publications were identified, of which 2,529 were excluded. 22 studies were included for analysis. COVID-19 disease severity was poorly documented across studies and with widely varied definitions. The reported association between cardiac injury and coronavirus disease severity had high heterogeneity across studies (I2=99.10%). The overall effect size was non-significant (p=0.07, CI −0.02–0.47). However, a subgroup analysis of 33 studies from the same search reported a significant association between cardiac injury and ICU admission (p=0.00, CI 0.49–0.94). Whilst this review does not suggest a significant association between cardiac injury and overall disease severity, there is a correlation with rate of ICU admission, which may serve as a surrogate marker of disease severity. Findings may be limited by the high degree of variability of severity definitions across studies. Use of a standardised definition of disease severity in COVID-19, such as that described by the WHO may improve reliability of the findings.