Association between Troponin I and Mortality in COVID-19 Patients: Meta-Analysis Study
Abstract
Background: COVID-19 is a new disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 became a pandemic disease that killed 4 million people for almost 2 years. COVID-19 patients with comorbidities or risk factors are more prone to have a worse prognosis, one of which is heart disease which can be checked through troponin I values. This study aimed to determine the relationship between troponin I levels and mortality in patients with COVID-19.
Subjects and Method: This was a systematic review and meta-analysis by searching for articles from databases such as Science Direct, Springer, Google Scholar, and PubMed using the keywords: troponin I, cohort, fatality, cardiac biomarker, death, coronavirus, COVID-19 mortality, and COVID-19. Ten accredited articles published between 2019-2021 were included for meta-analysis. The subjects of this study were 10,499 COVID-19 patients. The intervention in this study was high troponin I levels, while the comparison was normal troponin I levels. The outcome of this study is mortality in COVID-19 patients. Data processing using Review Manager software version 5.3 for the relationship between troponin I levels and mortality in COVID-19 patients.
Results: From a meta-analysis of 10 primary research articles in China, Spain, New York (United States), France, Turkey, and Philadelphia (United States) showed an association between high troponin I levels and an increased risk of mortality in COVID-19 patients (aOR= 3.07; 95% CI= 1.68 to 5.61; p<0.003).
Conclusion: High troponin I levels increase the risk of mortality in COVID-19 patients.
Keywords: troponin I, heart disease, mortality, COVID-19.
Correspondence: Hesthi Krisnawati. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: hesthikrisna86@gmail.com. Mobile: +6285278067840.
Indonesian Journal of Medicine (2021), 06(03): 347-353
https://doi.org/10.26911/theijmed.2021.06.03.12
References
Cetinkal G, Kocas BB, Ser OS, Kilci H, Keskin K, Ozcan SN, Verdi Y, et al. (2020). Assessment of the modified cha2ds2vasc risk score in predicting mortality in patients hospitalized with COVID-19. Am. J. Cardiol. 1-7. https://doi.org/10.1016/j.amjcard.2020.08.040.
Chen H, Li X, Marmar T, Xu Q, Tu J, Li T, Han J, et al. (2021). Cardiac troponin i association with critical illness and death risk in 726 seriously ill COVID-19 patients: a retrospective cohort study. Int. j. med. sci. res. 18(6): 1474–1483.https://doi.org/10.7150/ijms.536-41.
Chen LQ, Burdowski J, Marfatia R, Weber J, Gliganic K, Diaz N, Ramjattan N, et al. (2020). Reduced cardiac function is associated with cardiac injury and mortality risk in hospitalized COVID-19 Patients. Clin. Cardiol. 43(12): 1547–1554. https://doi.org/10.1002/clc.23479.
Cordeanu EM, Duthil N, Severac F, Lambach H, Tousch J, Jambert L, Mirea C, et al. (2020). Prognostic value of troponin elevation in COVID-19 hospitalized patients. J Clin Med. 9(12): 4078. https://doi.org/10.3390/jcm9124078.
Du R, Liang L, Yang C, Wang W, Cao T, Li M, Guo G, et al. (2020). Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: a prospective cohort study. Eur. Respir. J. 55:1-8. https://doi.org/10.1183/13993003.00524-2020.
Guadiana LG, Morell RD, Rodríguez GO, Indiano CM, María A, Padilla L, Miquel J, et al. (2021). Cardiac troponin and COVID-19 severity: results from biocovid study. Eur J Clin Invest. 1–12. https://doi.org/10.1111/eci.13532.
Harmouch F, Shah K, Hippen JT, Kumar A, Goel H (2021). Is it all in the heart? Myocardial injury as major predictor of mortality among hospitalized COVID‐19 patients. J. Med. Virol. 93: 973-982. https://doi.org/0.1002/jmv.26347.
Levani Y, Prastya AD, Mawaddatunnadila S, Wuhan K, Huebei P (2019). Coronavirus Disease 2019 (COVID-19): patogenesis, manifestasi klinis dan pilihan terapi. jurnal kedokteran dan kesehatan. 17(1): 44-57. https://doi.org/10.24853/jkk.17.1.44-57.
Majure DT, Gruberg L, Saba SG, Kvasnovsky C, Hirsch JS, Jauhar R (2021). Usefulness of elevated troponin to predict death in patients with COVID-19 and myocardial injury. Am J Cardiovasc. 138: 100–106. https://doi.org/10.1016/j.amjcard.2020.09.060.
Manocha KK, Kirzner J, Ying X, Yeo I, Peltzer B, Ang B, Li HA, et al. (2020). Troponin and other biomarker levels and outcomes among patients hospitalized with COVID-19: derivation and validation of the ha2t2 COVID-19 mortality risk score. J. Am.Heart Assoc. 1-12. https://doi.org/10.1161/JAHA.120.018477.
Muhammad R, Ogunti R, Ahmed B, Munawar M, Donaldson S, Sumon M, Kibreab A, et al. (2020). Clinical characteristics and predictors of mortality in minority patients hospitalized with COVID-19 infection. J. Racial and Ethn Health Disparities. https://doi.org/10.1007/s40615-020-00961-x.
Murti B (2018). Prinsip dan Metode Riset Epidemiologi. Karanganyar: Bintang Fajar Offset.
Nie SF, Yu M, Xie T, Yang F, Wang HB, Wang ZH, Li M, et al. (2020). Cardiac troponin I is an independent predictor for mortality in hospitalized patients with COVID-19. Circ. 142(6): 608–610. https://doi.org/10.1161/CIRCU-LATIONAHA.120.048-789.
Ozyilmaz S, Alis EE, Ermis E, Allahverdiyev S, Ucar H. (2020). Assessment of the relationship between mortality and troponin I levels in hospitalized patients with the novel coronavirus (COVID-19). Medicina. 56(693):1-12.https://doi.org/10.3390-/medicina56120693.
Pane MDC (2021a). COVID-19. Retrieved from dari Alodokter, 23 Juli 2021 website: https://www.alodokter.com/COVID-19.
Pane MDC (2021b). Virus Corona. Retrieved from Alodokter, 23 Juli 2021 website: https://www.alodokter.com/virus-corona.
Satria RMA, Tutupoho RP, Chalidyanto D. (2020). Analisis faktor risiko kematian dengan penyakit komorbid COVID-19. Jurnal Keperawatan Silampari. 4: 48–55. https://doi.org/10.31539/jks.v4i1.1587.
The Joanna Briggs Institute (2017). Critical Appraisal tools for use in JBI Systematic Reviews Checklist for Cohort Studies. http://joannabriggs.org/research/critical-appraisal-tools.html.
WHO (2021). WHO: Coronavirus (COVID-19) Disease Dashboard. Retrieved from https://covid19.who.int/.
Woo SH, Rios-Diaz AJ, Kubey AA, Cheney-Peters DR, Ackermann LL, Chalikon-da DM, Venkataraman CM, et al. (2021). Development and validation of a web-based severe COVID-19 risk prediction model. Am. J. Med. Sci., 1-28. https://doi.org/10.1016/j.amjms.-2021.04.001.