Gu Zhi-Chun, Zhang Chi, Kong Ling-Cong, Shen Long, Li Zheng, Ge Heng, Lin Hou-Wen, Pu Jun
Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Cardiovasc Diagn Ther. 2020 Aug;10(4):667-677. doi: 10.21037/cdt-20-535.
Coronavirus disease 2019 (COVID-19) has become global pandemic and resulted in considerable morbidity and mortality since December 2019. Information on the incidence of myocardial injury remains scarce.
English-language databases (PubMed, Embase, Cochrane), Chinese-language databases (CNKI, VIP, WANFANG), and preprint platform were searched to identify studies that reported the myocardial injury data in COVID-19 patients. Random-effects meta-analyses were used to derive the pooled incidence and relative risks (RRs) of myocardial injury. Variations by disease severity were examined by subgroup analyses. Sensitivity analyses were performed to strengthen the results. Meta-regression was applied to explore the risk factors associated with myocardial injury.
A total of 53 studies involving 7,679 patients were included. The pooled incidence of myocardial injury was 21% [95% confidence interval (CI), 17-25%; I, 96.5%]. The highest incidence of myocardial injury was found in non-survivors (66%; 95 CI%, 54-78%; I, 85.7%), followed by severe patients (43%; 95 CI%, 33-53%; I, 93.0%) and non-severe patients (11%; 95 CI%, 7-15%; I, 95.2%). Higher risk of myocardial injury was detected in severe patients than non-severe patients (RR, 5.74; 95% CI, 3.74-8.79; I, 86.8%). All the sensitivity analyses confirmed the robustness of primacy results.
This meta-analysis showed that myocardial injury occurred in 21% of COVID-19 patients. An elevated rate was observed in non-survivors (66%) and severe patients (43%). Severe patients had a 4.74-fold increase in the risk of myocardial injury than non-severe patients. Aggressive strategy may be considered for COVID-19 patients at high risk of myocardial injury.
自2019年12月以来，2019冠状病毒病（COVID-19）已成为全球大流行疾病，并导致了相当高的发病率和死亡率。关于心肌损伤发病率的信息仍然匮乏。
检索英文数据库（PubMed、Embase、Cochrane）、中文数据库（中国知网、维普、万方）和预印本平台，以识别报告COVID-19患者心肌损伤数据的研究。采用随机效应荟萃分析得出心肌损伤的合并发病率和相对风险（RRs）。通过亚组分析检查疾病严重程度的差异。进行敏感性分析以强化结果。应用荟萃回归探索与心肌损伤相关的危险因素。
共纳入53项研究，涉及7679例患者。心肌损伤的合并发病率为21%[95%置信区间（CI），17 - 25%；I²，96.5%]。心肌损伤发病率最高的是非幸存者（66%；95%CI，54 - 78%；I²，85.7%），其次是重症患者（43%；95%CI，33 - 53%；I²，93.0%）和非重症患者（11%；95%CI，7 - 15%；I²，95.2%）。与非重症患者相比，重症患者心肌损伤风险更高（RR，5.74；95%CI，3.74 - 8.79；I²，86.8%）。所有敏感性分析均证实了主要结果的稳健性。
这项荟萃分析表明，21%的COVID-19患者发生了心肌损伤。非幸存者（66%）和重症患者（43%）的发病率有所升高。与非重症患者相比，重症患者心肌损伤风险增加了4.74倍。对于有心肌损伤高风险的COVID-19患者，可考虑采取积极策略。
