Cardiac injury is associated with mortality and critically ill pneumonia in COVID-19: A meta-analysis

Am J Emerg Med. 2021 Jun;44:352-357. doi: 10.1016/j.ajem.2020.04.052. Epub 2020 Apr 19.


Background: In this systematic review and meta-analysis, we aimed to explore the association between cardiac injury and mortality, the need for intensive care unit (ICU) care, acute respiratory distress syndrome (ARDS), and severe coronavirus disease 2019 (COVID-19) in patients with COVID-19 pneumonia.

Methods: We performed a comprehensive literature search from several databases. Definition of cardiac injury follows that of the included studies, which includes highly sensitive cardiac troponin I (hs-cTnl) >99th percentile.The primary outcome was mortality, and the secondary outcomes were ARDS, the need for ICU care, and severe COVID-19. ARDS and severe COVID-19 were defined per the World Health Organization (WHO) interim guidance of severe acute respiratory infection (SARI) of COVID-19.

Results: There were a total of 2389 patients from 13 studies. This meta-analysis showed that cardiac injury was associated with higher mortality (RR 7.95 [5.12, 12.34], p < 0.001; I2: 65%). Cardiac injury was associated with higher need for ICU care (RR 7.94 [1.51, 41.78], p = 0.01; I2: 79%), and severe COVID-19 (RR 13.81 [5.52, 34.52], p < 0.001; I2: 0%). The cardiac injury was not significant for increased risk of ARDS (RR 2.57 [0.96, 6.85], p = 0.06; I2: 84%). The level of hs-cTnI was higher in patients with primary + secondary outcome (mean difference 10.38 pg/mL [4.44, 16.32], p = 0.002; I2: 0%).

Conclusion: Cardiac injury is associated with mortality, need for ICU care, and severity of disease in patients with COVID-19.

Keywords: COVID-19; Cardiac injury; Coronavirus; Mortality; Troponin.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adult
  • COVID-19 / complications
  • COVID-19 / mortality*
  • Critical Illness / mortality
  • Heart Diseases / etiology
  • Heart Diseases / mortality
  • Heart Diseases / virology*
  • Humans
  • Intensive Care Units / statistics & numerical data
  • Risk Factors