Prognostic value of Cardiac Biomarkers in COVID-19 Infection: A Meta-analysis

BACKGROUND: Multiple Biomarkers have recently been shown to be elevated in COVID-19, a respiratory infection with multi-organ dysfunction; however, information regarding the prognostic value of cardiac biomarkers as it relates to disease severity and cardiac injury are inconsistent. RESEARCH QUESTION: The goal of this meta-analysis was to summarize the evidence regarding the prognostic relevance of cardiac biomarkers from data available in published reports. STUDY DESIGN AND METHODS: PubMed was searched from inception through April 2020 for studies comparing median values of cardiac biomarkers in critically ill versus non-critically ill COVID-19 patients, or patients who died versus those who survived. The weighted mean differences (WMD) and 95% confidence interval (CI) between the groups were calculated for each study and combined using a random effects meta-analysis model. The odds ratio (OR) for mortality based on cardiac injury was combined from studies reporting it. RESULTS: Troponin levels were significantly higher in COVID-19 patients who died or were critically ill versus those who were alive or not critically ill (WMD 0.58, 95% CI 0.42–0.71, p<0.001). Cardiac injury was independently associated with significantly increased odds of mortality (OR 6.641, 95% CI 1.26 – 35.1, p=0.03). No difference in BNP was seen between the two groups. A significant difference in levels of D-dimer was seen in those who died or were critically ill. CK levels were only significantly higher in those who died versus those who were alive (WMD 0.47 95% CI 0.09–0.84, p=0.014). INTERPRETATION: Cardiac biomarkers add prognostic value to the determination of the severity of COVID-19 and can predict mortality.