Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Aug 28, 2021; 9(4): 342-352
Published online Aug 28, 2021. doi: 10.13105/wjma.v9.i4.342
Troponin I biomarker as a strong prognostic factor for predicting COVID-19 mortality: A systematic review
Haleh Ashraf, Abbas Soleimani, Ali Kazemi saeid, Azadeh Sadat Naseri, Fazeleh Majidi, Niloufar Peirovi, Shahrokh Karbalai Saleh
Haleh Ashraf, Abbas Soleimani, Ali Kazemi saeid, Azadeh Sadat Naseri, Shahrokh Karbalai Saleh, Department of Cardiology, Tehran University of Medical Sciences, Tehran 1136746911, Iran
Haleh Ashraf, Cardiac Primary Prevention Research Center (CPPRC), Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran, zip code 1411713138
Fazeleh Majidi, Niloufar Peirovi, Reserch and Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran 1136746911, Iran
Author contributions: Ashraf H, Soleimani A, Kazemi saeid A, Sadat Naseri A, Majidi F, Peirovi N, Karbalai Saleh S have contributed equally and provided critical feedback and helped shape the research, analysis, and manuscript.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shahrokh Karbalai Saleh, MD, Assistant Professor, Department of Cardiology, Tehran University of Medical Sciences, Imam Khomeini St. Sina Hospital, Tehran 1136746911, Iran. saleh6948@yahoo.com
Received: March 28, 2021
Peer-review started: March 28, 2021
First decision: April 28, 2021
Revised: July 3, 2021
Accepted: August 24, 2021
Article in press: August 24, 2021
Published online: August 28, 2021
Abstract
BACKGROUND

The increase in circulating Troponin-I in the blood of patients suffering coronavirus disease 2019 (COVID-19) can be a strong prognostic factor for predicting disease poorer outcome.

AIM

To review the literatures to approve this claim systematically.

METHODS

Two blinded reviewers independently screened the titles and abstracts of the manuscripts using the keywords and deeply searching the databanks including PubMed, Scopus, Google Scholar, and Web of knowledge, followed by profoundly appraisement of the full texts to assess the inclusion appropriateness.

RESULTS

The manuscripts entered into our final assessment were categorized as the two groups including 10 manuscripts describing and comparing death and disease-related complications between the subgroups of patients with raised serum troponin level and those with normal ranges of this biomarker and 7 manuscripts comparing the mean level of serum troponin concentration across the survived and non-survived groups. Comparing outcome of COVID-19 disease in the groups with raised troponin level and normal level of this markers showed increased the likelihood of death [hazard ratio (HR) = 4.967, P < 0.001], acute respiratory distress syndrome (HR = 5.914, P < 0.001), acute kidney injury (HR = 3.849, P < 0.001), and intensive care unit (ICU) admission (HR = 3.780, P < 0.001) following raise of troponin. The pooled analysis showed significantly higher concentration of this marker in the survived group compared to non-survived group (weighted mean differences of 22.278, 95%CI: 15.647 to 28.927, P < 0.001).

CONCLUSION

Raising troponin-I on admission can be linked to the increase risk for in-hospital death, acute respiratory distress syndrome, kidney injury, and ICU admission by 4.9, 5.9, 3.8, and 3.7 times as compared to those with initial normal troponin-I concentration. Thus, raising baseline value of troponin-I can be used as a prognostic factor for poor outcome of COVID-19.

Keywords: Troponin-I, COVID-19, Mortality, Morbidity, Cardiac biomarker, Acute respiratory distress syndrome

Core Tip: We systematically reviewed the literatures to assess this claim that an increase in troponin-I levels could be a prognostic factor in predicting disease severity and mortality in patients with coronavirus disease 2019. According to our findings, regardless of the history of myocardial injuries or the presence of cardiovascular risk profile, the value of troponin I should be accurately assessed on admission. Raising troponin-I on admission can be linked to the increase risk for in-hospital death, acute respiratory distress syndrome, kidney injury, and intensive care unit admission by 4.9, 5.9, 3.8, and 3.7 times as compared to those with initial normal troponin I concentration.