Prognostic value of cardiac biomarkers in COVID-19 infection

Aakash Sheth,Desiree' Dawson,Malak Modi,Paari Dominic

doi:10.1038/s41598-021-84643-6

Abstract

Multiple Biomarkers have recently been shown to be elevated in COVID-19, a respiratory infection with multi-organ dysfunction; however, information regarding the prognostic value of cardiac biomarkers as it relates to disease severity and cardiac injury are inconsistent. The goal of this meta-analysis was to summarize the evidence regarding the prognostic relevance of cardiac biomarkers from data available in published reports. PubMed, Embase and Web of Science were searched from inception through April 2020 for studies comparing median values of cardiac biomarkers in critically ill versus non-critically ill COVID-19 patients, or patients who died versus those who survived. The weighted mean differences (WMD) and 95% confidence interval (CI) between the groups were calculated for each study and combined using a random effects meta-analysis model. The odds ratio (OR) for mortality based on cardiac injury was combined from studies reporting it. Troponin levels were significantly higher in COVID-19 patients who died or were critically ill versus those who were alive or not critically ill (WMD 0.57, 95% CI 0.43–0.70, p < 0.001). Additionally, BNP levels were also significantly higher in patients who died or were critically ill (WMD 0.45, 95% CI − 0.21–0.69, p < 0.001). Cardiac injury was independently associated with significantly increased odds of mortality (OR 6.641, 95% CI 1.26–35.1, p = 0.03). A significant difference in levels of D-dimer was seen in those who died or were critically ill. CK levels were only significantly higher in those who died versus those who were alive (WMD 0.79, 95% CI 0.25–1.33, p = 0.004). Cardiac biomarkers add prognostic value to the determination of the severity of COVID-19 and can predict mortality.

Highlights

Multiple Biomarkers have recently been shown to be elevated in COVID-19, a respiratory infection with multi-organ dysfunction; information regarding the prognostic value of cardiac biomarkers as it relates to disease severity and cardiac injury are inconsistent
Possible mechanisms of myocardial injury caused by COVID-19, termed acute COVID-19 cardiovascular syndrome (ACovCS), include heightened myocardial demand in response to the stress of infection, inflammatory cytokines creating a thrombogenic environment as the result of platelet activation and
For the analysis of measures of central tendency of cardiac biomarkers in COVID-19 patients who died or were critically ill, median biomarker values were extracted for patients who died or were critically ill and patients who survived and/or were not critically ill, and the weighted mean differences (WMD) and 95% confidence interval (CI) between these two groups were calculated for each study

Summary

Introduction

Multiple Biomarkers have recently been shown to be elevated in COVID-19, a respiratory infection with multi-organ dysfunction; information regarding the prognostic value of cardiac biomarkers as it relates to disease severity and cardiac injury are inconsistent. The goal of this metaanalysis was to summarize the evidence regarding the prognostic relevance of cardiac biomarkers from data available in published reports. Observational studies in China and reports from The Centers for Disease Control and Prevention (CDC) suggest that patients with pre-existing heart conditions are more likely to develop severe illness from COVID-195. We present a meta-analysis of 16 observational studies from China to shed further light on this topic

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Conclusion