The Impact of Cardiac Injury on COVID-19 Patients Mortality: A Systematic Review and Meta-Analysis

Nisa Amnifolia Niazta,Hiradipta Ardining,Muchammad Dzikrul Haq Karimullah

doi:10.21776/ub.hsj.2020.001.04.05

Abstract

Background: Cardiovascular system was the second most common organ system affected by COVID-19. Cardiac injury has been reported in many COVID-19 cases. The purpose of this study was to investigate the correlation between cardiac injury with mortality in COVID-19 patients. Methods: We performed a systematic review and meta-analysis study. The relevant studies were identified through scientific electronic databases such as PubMed, Cochrane, and ScienceDirect up to August 2020. The study quality assessment was conducted using the GRADE approach. The pooled odds ratio (OR) and 95% confidence interval (CI) were estimated using the random-effects model. Results: A total of 10 studies involving 2619 patients were included in the meta-analysis. The incidence of cardiac injury in COVID-19 patients was 28.5%. The all-cause mortality was significantly higher in patients with cardiac injury (52.8% vs. 13.1%; OR = 13.78; 95% CI = 7.22-26.32; I 2 = 88%; Z= 7.95; P < 0.00001). Conclusion: Cardiac injury is associated with higher mortality in COVID-19 patients. The cardiac injury should be considered as an important variable in the risk stratification for mortality in COVID-19.

Highlights

COVID-19 has been an emerging global health issue
Inclusion criteria were: (1) cohort, case-control, or case series study; (2) study included all patients with confirmed COVID-19 using PCR; (3) available data of the presence of cardiac injury, which was defined as an increased troponin level; (4) available data of mortality in cardiac injury patients compared to mortality in non-cardiac injury patients
The all-cause mortality was significantly higher in patients with cardiac injury (52.8% vs. 13.1%; odds ratio (OR) = 13.78; 95% confidence interval (CI) = 7.22-26.32; I 2 = 88%; Z= 7.95; P < 0.00001) as shown in figure 2

Summary

Introduction

COVID-19 has been an emerging global health issue. The numbers of COVID-19 patients continue to increase, with 25 million confirmed cases from January to August 2020.1 In Indonesia, over 170 thousand confirmed cases were reported at the end of August 2020. The case fatality rate in Indonesia was 4.2%, higher than the global average case fatality rate, which is 3.4%.1,2. On August 31, 2020, Indonesia was the runner-up for the mortality rate caused by COVID-19 in Southeast Asia, under the Philippines. The mortality rate in Indonesia was 28 per million, while the Philippines was 33.9 per million.[3] Due to its high mortality rate, the identification of predictors of progression towards fatal disease is urgently needed, as we are still encountering difficulties in how to identify patient at risk for severe disease early in the course of COVID-19.4. The goal of this study was to explore the correlation of cardiac injury with mortality in patients with COVID-19. The all-cause mortality was significantly higher in patients with cardiac injury (52.8% vs 13.1%; OR = 13.78; 95% CI = 7.22-26.32; I 2 = 88%; Z= 7.95; P < 0.00001). As a major aspect in the risk stratification for COVID-19 mortality, cardiac damage should be considered

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Conclusion