优化的心肌肌钙蛋白浓度升高截断值预测成人 COVID-19 患者心肌损伤的临床结局：系统评价的剂量-反应分析方案。

Optimal cut-off value of elevated cardiac troponin concentrations for myocardial injury predicts clinical outcomes in adult patients with COVID-19: a dose-response analysis protocol for systematic review.

机构信息

Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

Department of Cardiology, First Affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia, China.

出版信息

BMJ Open. 2021 Jan 8;11(1):e046575. doi: 10.1136/bmjopen-2020-046575.

DOI:10.1136/bmjopen-2020-046575

PMID:33419919

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7798426/

Abstract

INTRODUCTION

Acute myocardial injury in patients with COVID-19 infection has been recognised as one important complication associated with in-hospital mortality. The potential dose-response effect of cardiac troponin (cTn) concentrations on adverse clinical outcomes has not been systematically studied. Hence, we will conduct a comprehensive dose-response meta-analysis to quantitatively evaluate the relationship between elevated cTn concentrations and in-hospital adverse clinical outcomes in patients with COVID-19.

METHODS

We will search PubMed, EMBASE, Cochrane Library and ISI Knowledge via Web of Science databases, as well as preprint databases (medRxiv and bioRxiv), from inception to October 2021, to identify all retrospective and prospective cohorts and randomised controlled studies using related keywords. The primary outcome will be all-cause mortality during hospitalisation. The secondary outcome will be major adverse event (MAE). To conduct a dose-response meta-analysis of the potential linear or restricted cubic spline regression relationship between elevated cTn concentrations and all-cause mortality or MAE, studies with three or more categories of cTn concentrations will be included. Univariable or multivariable meta-regression and subgroup analyses will be conducted to compare elevated and non-elevated categories of cTn concentration. Sensitivity analyses will be used to assess the robustness of our results by removing each included study at one time to obtain and evaluate the remaining overall estimates of all-cause mortality or MAE.

ETHICS AND DISSEMINATION

In accordance with the Institutional Review Board/Independent Ethics Committee of Fuwai Hospital, ethical approval was waived for this systematic review protocol. This meta-analysis will be disseminated through a peer-reviewing process for journal publication and conference communication.

PROSPERO REGISTRATION NUMBER

CRD42020216059.

摘要

简介

COVID-19 感染患者的急性心肌损伤已被认为是与住院死亡率相关的重要并发症之一。心肌肌钙蛋白（cTn）浓度对不良临床结局的潜在剂量-反应效应尚未得到系统研究。因此，我们将进行一项综合的剂量-反应荟萃分析，定量评估 COVID-19 患者 cTn 浓度升高与住院期间不良临床结局之间的关系。

方法

我们将从建库至 2021 年 10 月，通过 PubMed、EMBASE、Cochrane 图书馆和 ISI Web of Science 数据库以及预印本数据库（medRxiv 和 bioRxiv），使用相关关键词搜索所有回顾性和前瞻性队列研究和随机对照研究。主要结局为住院期间全因死亡率。次要结局为主要不良事件（MAE）。对于 cTn 浓度升高与全因死亡率或 MAE 之间潜在线性或限制性立方样条回归关系的剂量-反应荟萃分析，将纳入具有三个或更多 cTn 浓度类别的研究。将进行单变量或多变量荟萃回归和亚组分析，以比较 cTn 浓度升高和非升高类别。通过每次删除一项纳入研究来进行敏感性分析，以评估结果的稳健性，并获得和评估全因死亡率或 MAE 的剩余总体估计值。