Wibowo Arief, Pranata Raymond, Akbar Mohammad Rizki, Purnomowati Augustine, Martha Januar Wibawa
Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia.
Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia; Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia.
Int J Infect Dis. 2021 Apr;105:312-318. doi: 10.1016/j.ijid.2021.02.113. Epub 2021 Mar 2.
Cardiac injury is frequently encountered in patients with coronavirus disease 2019 (COVID-19) and is associated with increased risk of mortality. Elevated troponin may signify myocardial damage and is predictive of mortality. This study aimed to assess the prognostic value of troponin above the 99th percentile upper reference limit (URL) for mortality, and factors affecting the relationship.
A comprehensive literature search of PubMed (MEDLINE), Scopus and Embase was undertaken, from inception of the databases until 16 December 2020. The key exposure was elevated serum troponin, defined as troponin (of any type) above the 99th percentile URL. The outcome was mortality due to any cause.
In total, 12,262 patients from 13 studies were included in this systematic review and meta-analysis. The mortality rate was 23% (20-26%). Elevated troponin was observed in 31% (23-38%) of patients. Elevated troponin was associated with increased mortality [odds ratio (OR) 4.75, 95% confidence interval (CI) 4.07-5.53; P < 0.001; I = 19.9%]. Meta-regression showed that the association did not vary with age (P = 0.218), male gender (P = 0.707), hypertension (P = 0.182), diabetes (P = 0.906) or coronary artery disease (P = 0864). The association between elevated troponin and mortality had sensitivity of 0.55 (0.44-0.66), specificity of 0.80 (0.71-0.86), positive likelihood ratio of 2.7 (2.2-3.3), negative likelihood ratio of 0.56 (0.49-0.65), diagnosis odds ratio of 5 (4-5) and area under the curve of 0.73 (0.69-0.77). The probability of mortality was 45% in patients with elevated troponin and 14% in patients with non-elevated troponin.
Elevated troponin was associated with mortality in patients with COVID-19 with 55% sensitivity and 80% specificity.
2019冠状病毒病（COVID-19）患者经常出现心脏损伤，且与死亡风险增加相关。肌钙蛋白升高可能意味着心肌损伤，并可预测死亡率。本研究旨在评估肌钙蛋白高于第99百分位参考上限（URL）对死亡率的预后价值，以及影响这种关系的因素。
对PubMed（MEDLINE）、Scopus和Embase进行全面的文献检索，检索时间从各数据库建立至2020年12月16日。主要暴露因素为血清肌钙蛋白升高，定义为（任何类型的）肌钙蛋白高于第99百分位URL。结局为任何原因导致的死亡。
本系统评价和荟萃分析共纳入了13项研究中的12262例患者。死亡率为23%（20%-26%）。31%（23%-38%）的患者肌钙蛋白升高。肌钙蛋白升高与死亡率增加相关[比值比（OR）4.75，95%置信区间（CI）4.07-5.53；P<0.001；I²=19.9%]。Meta回归显示，这种关联在年龄（P=0.218）、男性（P=0.707）、高血压（P=0.182）、糖尿病（P=0.906）或冠状动脉疾病（P=0.864）方面没有差异。肌钙蛋白升高与死亡率之间的关联敏感性为0.55（0.44-0.66），特异性为0.80（0.71-0.86），阳性似然比为2.7（2.2-3.3），阴性似然比为0.56（0.49-0.65），诊断比值比为5（4-5），曲线下面积为0.73（0.69-0.77）。肌钙蛋白升高患者的死亡概率为45%，肌钙蛋白未升高患者的死亡概率为14%。
肌钙蛋白升高与COVID-19患者的死亡率相关，敏感性为55%，特异性为80%。
