Li Yuehua, Pei Hanjun, Zhou Chenghui, Lou Ying
Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cardiology, The First Affiliated Hospital of Baotou Medical College, Baotou, China.
Front Cardiovasc Med. 2022 May 2;9:850447. doi: 10.3389/fcvm.2022.850447. eCollection 2022.
Predictive value of myocardial injury as defined by elevated cardiac tropnins (cTns) in patients with COVID-19 has not been fully investigated. We performed a meta-analysis to evaluate the dose-response relationship between myocardial injury and short-term all-cause mortality.
Pubmed, Embase, and the Cochrane Library database were searched for all the studies which evaluated the relationship between cTns and the risk of short-term all-cause mortality in patients with COVID-19.
Compared with patients without myocardial injury, the group with elevated cTns was associated with increased short-term mortality (11 studies, 29,128 subjects, OR 3.17, 95% CI 2.19-4.59, = 0.000, = 92.4%, for heterogeneity 0.00). For the dose-response analysis, the elevation of cTns 1 × 99th percentile upper reference limit (URL) was associated with increased short-term mortality (OR 1.99, 95% CI 1.53-2.58, = 0.000). The pooled OR of short-term mortality for each 1 × URL increment of cTns was 1.25 (95% CI 1.22-1.28, = 0.000).
We found a positive dose-response relationship between myocardial injury and the risk of short-term all-cause mortality, and propose elevation of cTns > 1 × 99th percentile URL was associated with the increased short-term risk of mortality.
新冠病毒病（COVID-19）患者中，心肌肌钙蛋白（cTn）升高所定义的心肌损伤的预测价值尚未得到充分研究。我们进行了一项荟萃分析，以评估心肌损伤与短期全因死亡率之间的剂量反应关系。
检索了PubMed、Embase和Cochrane图书馆数据库，查找所有评估cTn与COVID-19患者短期全因死亡风险之间关系的研究。
与无心肌损伤的患者相比，cTn升高的组短期死亡率增加（11项研究，29128名受试者，OR 3.17，95%CI 2.19 - 4.59，P = 0.000，I² = 92.4%，异质性P = 0.00）。对于剂量反应分析，cTn升高至第99百分位数上限参考值（URL）的1倍与短期死亡率增加相关（OR 1.99，95%CI 1.53 - 2.58，P = 0.000）。cTn每增加1倍URL，短期死亡率的合并OR为1.25（95%CI 1.22 - 1.28，P = 0.000）。
我们发现心肌损伤与短期全因死亡风险之间存在正性剂量反应关系，并提出cTn升高>第99百分位数URL与短期死亡风险增加相关。
