Special Article - The impact of 2019 novel coronavirus on heart injury: A Systematic review and Meta-analysis

被引:135
作者
Li, Jing-Wei [1 ,2 ,3 ]
Han, Tian-Wen [1 ]
Woodward, Mark [2 ,4 ,5 ]
Anderson, Craig S. [2 ,6 ,7 ]
Zhou, Hao [1 ]
Chen, Yun-Dai [1 ]
Neal, Bruce [2 ,8 ,9 ]
机构
[1] Peoples Liberat Army Gen Hosp, Dept Cardiol, 28 Fuxing Rd, Beijing 100853, Peoples R China
[2] Univ New South Wales, George Inst Global Hlth, Fac Med, Kensington, NSW, Australia
[3] Army Mil Med Univ, Xinqiao Hosp, Dept Cardiol, Chongqing, Peoples R China
[4] Univ Oxford, George Inst Global Hlth, Oxford, England
[5] Johns Hopkins Univ, Dept Epidemiol, Baltimore, MD USA
[6] Peking Univ, George Inst China, Hlth Sci Ctr, Beijing, Peoples R China
[7] Heart Hlth Res Ctr, Beijing, Peoples R China
[8] Univ Sydney, Charles Perkins Ctr, Sydney, NSW, Australia
[9] Imperial Coll London, Dept Epidemiol & Biostat, London, England
基金
英国医学研究理事会;
关键词
Coronavirus; COVID-19; Cardiac injury; Mortality;
D O I
10.1016/j.pcad.2020.04.008
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Evidence about COVID-19 on cardiac injury is inconsistent. Objectives: We aimed to summarize available data on severity differences in acute cardiac injury and acute cardiac injury with mortality during the COVID-19 outbreak. Methods: We performed a systematic literature search across Pubmed, Embase and pre-print from December 1, 2019 to March 27, 2020, to identify all observational studies that reported cardiac specific biomarkers (troponin, creatine kinase-MB fraction, myoglobin, or NT-proBNP) during COVID-19 infection. We extracted data on patient demographics, infection severity, comorbidity history, and biomarkers during COVID-19 infection. Where possible, data were pooled for meta-analysis with standard (SMD) or weighted (WMD) mean difference and corresponding 95% confidence intervals (CI). Results: We included 4189 confirmed COVID-19 infected patients from 28 studies. More severe COVID-19 infection is associated with higher mean troponin (SMD 0.53, 95% CI 0.30 to 0.75, p < 0.001), with a similar trend for creatine kinase-MB, myoglobin, and NT-proBNP. Acute cardiac injury was more frequent in those with severe, compared to milder, disease (risk ratio 5.99, 3.04 to 11.80; p < 0.001). Meta regression suggested that cardiac injury biomarker differences of severity are related to history of hypertension (p = 0.030). Also COVID19-related cardiac injury is associated with higher mortality (summary risk ratio 3.85, 2.13 to 6.96; p < 0.001). hsTnI and NTproBNP levels increased during the course of hospitalization only in non-survivors. Conclusion: The severity of COVID-19 is associated with acute cardiac injury, and acute cardiac injury is associated with death. Cardiac injury biomarkers mainly increase in non-survivors. This highlights the need to effectively monitor heart health to prevent myocarditis in patients infected with COVID-19. (c) 2020 Published by Elsevier Inc.
引用
收藏
页码:518 / 524
页数:7
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