Prognostic performance of troponin in COVID-19: A diagnostic meta-analysis and meta-regression.
Prognostic performance of troponin in COVID-19: A diagnostic meta-analysis and meta-regression.
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DOI：
10.1016/j.ijid.2021.02.113
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发表时间：
2021-04
期刊：
影响因子：
--
通讯作者：
Martha JW
中科院分区：
文献类型：
--
作者：
Wibowo A;Pranata R;Akbar MR;Purnomowati A;Martha JW
2019 年冠状病毒病 (COVID-19) 患者经常会出现心脏损伤，并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预示着死亡。本研究旨在评估肌钙蛋白高于第 99 个百分位参考上限 (URL) 的死亡率的预后价值以及影响这种关系的因素。从数据库建立到 2020 年 12 月 16 日，对 PubMed (MEDLINE)、Scopus 和 Embase 进行了全面的文献检索。关键暴露是血清肌钙蛋白升高，定义为肌钙蛋白（任何类型）高于 URL 的第 99 个百分位。结果是由于任何原因导致的死亡。此次系统评价和荟萃分析总共纳入了来自 13 项研究的 12,262 名患者。死亡率为 23% (20-26%)。 31% (23-38%) 的患者观察到肌钙蛋白升高。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%]。荟萃回归显示，这种关联不随年龄（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 = 0864）而变化。肌钙蛋白升高与死亡率之间的关联的敏感性为 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）。肌钙蛋白升高的患者的死亡率为 45%，肌钙蛋白不升高的患者的死亡率为 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%。
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; I2 = 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.
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