Association of cardiac biomarkers and comorbidities with increased mortality, severity, and cardiac injury in COVID‐19 patients: A meta‐regression and Decision tree analysis

Toraih, Eman A.; Elshazli, Rami M.; Hussein, Mohammad H.; Elgaml, Abdelaziz; Amin, Mohamed Nasreldien; El‐Mowafy, Mohammed; El‐Mesery, Mohamed; Ellythy, Assem; Duchesne, Juan; Killackey, Mary T.; Ferdinand, Keith C.; Kandil, Emad; Fawzy, Manal S.

BACKGROUND: Coronavirus disease‐2019 (COVID‐19) has a deleterious effect on several systems, including the cardiovascular system. We aim to systematically explore the association of COVID‐19 severity and mortality rate with the history of cardiovascular diseases and/or other comorbidities and cardiac injury laboratory markers. METHODS: The standardized mean difference (SMD) or odds ratio (OR) and 95% confidence intervals (CI) were applied to estimate pooled results from the 56 studies. The prognostic performance of cardiac markers for predicting adverse outcomes and to select the best cutoff threshold was estimated by ROC curve analysis. Decision tree analysis by combining cardiac markers with demographic and clinical features was applied to predict mortality and severity in COVID‐19 patients. RESULTS: A meta‐analysis of 17,794 patients showed patients with high cardiac troponin I (OR=5.22, 95%CI=3.73‐7.31, p<0.001) and AST levels (OR=3.64, 95%CI=2.84‐4.66, p<0.001) were more likely to develop adverse outcomes. High troponin I >13.75 ng/L combined with either advanced age >60 years or elevated AST level >27.72 U/L was the best model to predict poor outcomes. CONCLUSIONS: COVID‐19 severity and mortality are complicated by myocardial injury. Assessment of cardiac injury biomarkers may improve the identification of those patients at the highest risk and potentially lead to improved therapeutic approaches. This article is protected by copyright. All rights reserved.