Abstract
BackgroundThe clinical significance of cardiac troponin measurement in patients hospitalised for coronavirus disease 2019 (covid-19) is uncertain. We investigated the prevalence of elevated troponins in these patients and its prognostic value for predicting mortality.MethodsStudies were identified by searching electronic databases and preprint servers. We included studies of hospitalised covid-19 patients that reported the frequency of troponin elevations above the upper reference limit and/or the association between troponins and mortality. Meta-analyses were performed using random-effects models.ResultsFifty-one studies were included. Elevated troponins were found in 20.8% (95% confidence interval [CI] 16.8–25.0 %) of patients who received troponin test on hospital admission. Elevated troponins on admission were associated with a higher risk of subsequent death (risk ratio 2.68, 95% CI 2.08–3.46) after adjusting for confounders in multivariable analysis. The pooled sensitivity of elevated admission troponins for predicting death was 0.60 (95% CI 0.54–0.65), and the specificity was 0.83 (0.77–0.88). The post-test probability of death was about 42% for patients with elevated admission troponins and was about 9% for those with non-elevated troponins on admission. There was significant heterogeneity in the analyses, and many included studies were at risk of bias due to the lack of systematic troponin measurement and inadequate follow-up.ConclusionElevated troponins were relatively common in patients hospitalised for covid-19. Troponin measurement on admission might help in risk stratification, especially in identifying patients at high risk of death when troponin levels are elevated. High-quality prospective studies are needed to validate these findings.Systematic review registrationPROSPERO CRD42020176747
Highlights
Coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV2) remains a pandemic, with considerable mortality and morbidity exerting pressure on global health-care systems
Prevalence of elevated troponins In total, 49 studies reported or allowed calculation of prevalence estimates for elevated troponins above the upper reference limit in patients hospitalised for covid19
The studies differed in patient population and timing of troponin measurement
Summary
Coronavirus disease 2019 (covid-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV2) remains a pandemic, with considerable mortality and morbidity exerting pressure on global health-care systems. Elevated troponins frequently occur in patients with conditions other than acute coronary syndromes, and the mechanisms are complex For this reason, the American College of Cardiology recommended that troponin is ordered for covid-19 patients only when the diagnosis of acute myocardial infraction is being considered on clinical grounds [9]. Some opinion papers advocated for systematic troponin testing in all covid-19 patients requiring hospital admission for prognostication purpose [11, 12]. These conflicting recommendations regarding the use of troponins in evaluating covid-19 patients reflect major gaps in our understanding of the clinical significance of elevated troponins in this context. We investigated the prevalence of elevated troponins in these patients and its prognostic value for predicting mortality
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