Cardiac troponins predict mortality in patients with COVID-19: A meta-analysis of adjusted risk estimates

      Critical illness and sepsis are often associated with a troponin rise.
      • Lippi G.
      • Cervellin G.
      • Sanchis-Gomar F
      Predicting mortality with cardiac troponins: recent insights from meta-analyses.
      ,
      • Vrsalovic M.
      Prognostic effect of cardiac troponin elevation in acute aortic dissection: a meta-analysis.
      Therefore, troponin, in daily clinical practice, is frequently used as a marker of disease severity and as a predictor of future unfavourable outcomes.
      • Lippi G.
      • Cervellin G.
      • Sanchis-Gomar F
      Predicting mortality with cardiac troponins: recent insights from meta-analyses.
      Recently, several studies including a recent paper in this Journal by Zheng and colleagues, investigated the prognostic role of biomarkers of myocardial injury (i.e. troponins) with mortality in hospitalized patients with coronavirus disease 2019 (COVID-19).
      • Zheng Z.
      • Peng F.
      • Xu B.
      • Zhao J.
      • Liu H.
      • Peng J.
      • Li Q.
      • Jiang C.
      • Zhou Y.
      • Liu S.
      • Ye C.
      • Zhang P.
      • Xing Y.
      • Guo H.
      • Tang W
      Risk factors of critical & mortal COVID-19 cases: a systematic literature review and meta-analysis.
      • Santoso A.
      • Pranata R.
      • Wibowo A.
      • Al-Farabi M.J.
      • Huang I.
      • Antariksa B
      Cardiac injury is associated with mortality and critically ill pneumonia in COVID-19: a meta-analysis.
      • Li J.W.
      • Han T.W.
      • Woodward M.
      • Anderson C.S.
      • Zhou H.
      • Chen Y.D.
      • Neal B
      The impact of 2019 novel coronavirus on heart injury: a systemic review and Meta-analysis.
      Of note, those meta-analyses included studies that reported primarily unadjusted effect estimates of increased in-hospital mortality with higher troponin levels. Compared to patients with normal troponin levels, those with elevated troponins and consequently worse outcome were older and had higher rates of comorbidities including coronary artery disease, hypertension, chronic kidney disease, and diabetes.
      • Zheng Z.
      • Peng F.
      • Xu B.
      • Zhao J.
      • Liu H.
      • Peng J.
      • Li Q.
      • Jiang C.
      • Zhou Y.
      • Liu S.
      • Ye C.
      • Zhang P.
      • Xing Y.
      • Guo H.
      • Tang W
      Risk factors of critical & mortal COVID-19 cases: a systematic literature review and meta-analysis.
      • Santoso A.
      • Pranata R.
      • Wibowo A.
      • Al-Farabi M.J.
      • Huang I.
      • Antariksa B
      Cardiac injury is associated with mortality and critically ill pneumonia in COVID-19: a meta-analysis.
      • Li J.W.
      • Han T.W.
      • Woodward M.
      • Anderson C.S.
      • Zhou H.
      • Chen Y.D.
      • Neal B
      The impact of 2019 novel coronavirus on heart injury: a systemic review and Meta-analysis.
      As a consequence, the final results of those studies showed a significant heterogeneity and markedly different risk estimates of mortality (risk ratios were 43.24, 3.85, and 7.95, and I2 were 34%, 90% and 65% for the studies of Zheng et al., Li et al., and Santoso et al. respectively).
      • Zheng Z.
      • Peng F.
      • Xu B.
      • Zhao J.
      • Liu H.
      • Peng J.
      • Li Q.
      • Jiang C.
      • Zhou Y.
      • Liu S.
      • Ye C.
      • Zhang P.
      • Xing Y.
      • Guo H.
      • Tang W
      Risk factors of critical & mortal COVID-19 cases: a systematic literature review and meta-analysis.
      • Santoso A.
      • Pranata R.
      • Wibowo A.
      • Al-Farabi M.J.
      • Huang I.
      • Antariksa B
      Cardiac injury is associated with mortality and critically ill pneumonia in COVID-19: a meta-analysis.
      • Li J.W.
      • Han T.W.
      • Woodward M.
      • Anderson C.S.
      • Zhou H.
      • Chen Y.D.
      • Neal B
      The impact of 2019 novel coronavirus on heart injury: a systemic review and Meta-analysis.
      Therefore, the crucial question is whether cardiac injury is an independent prognostic marker in COVID-19 or it is simply related to the burden of concomitant cardiovascular disease .
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