Myocardial Injury Predicts Risk of Short-Term All-Cause Mortality in Patients With COVID-19: A Dose-Response Meta-Analysis.

Objective: Predictive value of myocardial injury as defined by elevated cardiac tropnins (cTns) in patients with COVID-19 has not been fully investigated. We performed a meta-analysis to evaluate the dose-response relationship between myocardial injury and short-term all-cause mortality. Methods: Pubmed, Embase, and the Cochrane Library database were searched for all the studies which evaluated the relationship between cTns and the risk of short-term all-cause mortality in patients with COVID-19. Results: Compared with patients without myocardial injury, the group with elevated cTns was associated with increased short-term mortality (11 studies, 29,128 subjects, OR 3.17, 95% CI 2.19-4.59, P = 0.000, I 2 = 92.4%, P for heterogeneity 0.00). For the dose-response analysis, the elevation of cTns 1 × 99th percentile upper reference limit (URL) was associated with increased short-term mortality (OR 1.99, 95% CI 1.53-2.58, P = 0.000). The pooled OR of short-term mortality for each 1 × URL increment of cTns was 1.25 (95% CI 1.22-1.28, P = 0.000). Conclusion: We found a positive dose-response relationship between myocardial injury and the risk of short-term all-cause mortality, and propose elevation of cTns > 1 × 99th percentile URL was associated with the increased short-term risk of mortality.

Incidence, risk factors and prognostic effect of imaging left ventricular diastolic dysfunction in patients with COVID-19: protocol for a systematic review.

INTRODUCTION: Recent reports linked acute COVID-19 infection in critical patients to cardiac structure and function abnormalities. The left ventricular (LV) diastolic dysfunction could result in obvious adverse prognostic impacts. The aim of this meta-analysis is to summarise the incidence, risk factors and the prognostic effect of imaging LV diastolic dysfunction in adult patients with COVID-19. METHODS: Databases to be used for the pertinent literature are PubMed, EMBase, ISI Knowledge via Web of Science, and preprint databases (MedRxiv and BioRxiv) (until May 2023) to identify all cohort studies in adult patients with COVID-19. The primary outcome will be the incidence of LV diastolic dysfunction assessed by echocardiography or cardiac MRI. Secondary outcomes will include the risk factors for LV diastolic dysfunction and the association with all-cause mortality during hospitalisation. Additional outcomes will be septal or lateral é, average E/é, E/A, peak tricuspid regurgitation velocity, left atrial volume index and LV wall thickness. Univariable or multivariable meta-regression and subgroup analyses will be conducted for related risk factors and the association of LV diastolic dysfunction with all-cause mortality. Sensitivity analyses will be used to assess the robustness of our results by removing each included study at one time to obtain and evaluate the remaining overall estimates of LV diastolic dysfunction incidence and related risk factors, association with all-cause mortality and other LV diastolic dysfunction parameters. ETHICS AND DISSEMINATION: There was no need for ethics approval for the systematic review protocol according to the Institutional Review Board/Independent Ethics Committee of Fuwai Hospital. This meta-analysis will be disseminated through a peer-reviewed journal for publication. PROSPERO REGISTRATION NUMBER: CRD42021256666; URL: https://www.crd.york.ac.uk/prospero/.

Prevalence, classification, risk factors and outcome impact of delirium in patients with COVID-19: a meta-analysis protocol for systematic review.

INTRODUCTION: Previous studies have shown mixed results that delirium may result in a high risk of adverse clinical outcomes in patients with COVID-19. The aim of this meta-analysis is to summarise the evidence of prevalence, classification, risk factors and outcomes impact of delirium in adult patients with COVID-19. METHODS: A systematic search will be performed in PubMed, EMBase, ISI Knowledge via Web of Science and preprint databases (MedRxiv and BioRxiv) (from inception until June 2021) to identify all cohort studies concerning delirium in adult patients with COVID-19. The primary outcome will be the prevalence of delirium with different classifications (hyperactive, hypoactive or mixed type). The secondary outcomes will include the association of risk factors and the association with all-cause mortality during hospitalisation. Univariable or multivariable meta-regression and subgroup analyses will be conducted for the study design and patient characteristics. Sensitivity analyses were used to assess the robustness of our results by removing each included study at one time to obtain and evaluate the remaining overall estimates of primary and secondary outcomes. ETHICS AND DISSEMINATION: Ethical approval is not an essential element for the systematic review protocol in accordance with the Institutional Review Board /Independent Ethics Committee of Beijing Hospital. This meta-analysis will be disseminated through a peer-reviewed journal for publication. PROSPERO REGISTRATION NUMBER: CRD42020224871.

Does prior exposure to immune checkpoint inhibitors treatment affect incidence and mortality of COVID-19 among the cancer patients: The systematic review and meta-analysis.

BACKGROUND: Immune checkpoint inhibitors (ICIs) treatment among cancer patients has been shown to have antiviral effects by reactivating exhausted T cells. However, they could also trigger inflammatory storm. Therefore, prior exposure to ICIs may influence the risk of SARS-CoV2 infection and subsequent mortality. Recent results from studies of ICIs treatment on incidence and mortality of COVID-19 are controversial. MATERIALS AND METHODS: We searched databases PubMed, Embase, ISI of Knowledge, Cochrane Central Register of Controlled Trials (CENTRAL), as well as pre-print databases (MedRxiv and BioRxiv) for retrospective and prospective studies comparing ICIs versus other antitumor treatments in cancer patients in the area of COVID-19 pandemic. The primary outcome was the incidence of COVID-19. The secondary outcomes were mortality of COVID-19. RESULTS: Twenty-three studies with a total of 117,735 patients were selected. Compared with other antitumor treatments, prior exposure to ICIs had not an increased risk of incidence [Odds ratio (OR), 0.84; 95% confidence interval (CI), 0.60-1.18; P = 0.32] and mortality (OR, 1.22; 95% CI, 0.91-1.62; P = 0.18) of COVID-19 infectioin. Our subgroup and meta-regression analyses indicated that prior exposure to ICIs may reduce the incidence of COVID-19 in metastatic cancer patients. CONCLUSIONS: There was no significant difference on incidence and mortality of COVID-19 between prior exposure to ICIs with other anti-tumor treatments. ICIs may reduce infection susceptibility of COVID-19 in metastatic cancer patients.

Incidence, risk factors and prognostic effect of imaging right ventricular involvement in patients with COVID-19: a dose-response analysis protocol for systematic review.

INTRODUCTION: Emerging evidence has shown that COVID-19 infection may result in right ventricular (RV) disturbance and be associated with adverse clinical outcomes. The aim of this meta-analysis is to summarise the incidence, risk factors and the prognostic effect of imaging RV involvement in adult patients with COVID-19. METHODS: A systematical search will be performed in PubMed, EMBase, ISI Knowledge via Web of Science and preprint databases (MedRxiv and BioRxiv) (until October 2021) to identify all cohort studies in adult patients with COVID-19. The primary outcome will be the incidence of RV involvement (dysfunction and/or dilation) assessed by echocardiography, CT or MRI. Secondary outcomes will include the risk factors for RV involvement and their association with all-cause mortality during hospitalisation. Additional outcomes will include the RV global or free wall longitudinal strain (RV-GLS or RV-FWLS), tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC) and RV diameter. Univariable or multivariable meta-regression and subgroup analyses will be performed for the study design and patient characteristics (especially acute or chronic pulmonary embolism and pulmonary hypertension). Sensitivity analyses will be used to assess the robustness of our results by removing each included study at one time to obtain and evaluate the remaining overall estimates of RV involvement incidence and related risk factors, association with all-cause mortality, and other RV parameters (RV-GLS or RV-FWLS, TAPSE, S', FAC and RV diameter). Both linear and cubic spline regression models will be used to explore the dose-response relationship between different categories (>2) of RV involvement and the risk of mortality (OR or HR). ETHICS AND DISSEMINATION: There was no need for ethics approval for the systematic review protocol according to the Institutional Review Board/Independent Ethics Committee of Fuwai Hospital. This meta-analysis will be disseminated through a peer-reviewed journal for publication. PROSPERO REGISTRATION NUMBER: CRD42021231689.

Association of frailty status with adverse clinical outcomes in patients with COVID-19: protocol for a systematic review and dose-response meta-analysis.

INTRODUCTION: Frailty status has been recognised as an important prognostic factor of adverse clinical outcomes in various clinical settings. Recently, the role of frailty status in adverse clinical outcomes for COVID-19-infected patients has received increasing attention with controversial results. Hence, we will conduct a comprehensive dose-response meta-analysis to quantitatively evaluate the association between frailty status and adverse clinical outcomes in patients with COVID-19. METHODS: The researchers will systematically search PubMed, EMBase, Cochrane Library, ISI Knowledge via Web of Science and MedRxiv or BioRxiv databases (from inception until December 2020) to identify all retrospective and prospective cohort studies. All-cause mortality during hospitalisation will be set as the primary outcome. Univariable or multivariable meta-regression and subgroup analyses will be conducted for the comparison between frail versus non-frail categories. Sensitivity analyses will be used to assess the robustness of our results by removing each included study one at a time to obtain and evaluate the remaining overall estimates of all-cause mortality. To conduct a dose-response meta-analysis for the potential linear or restricted cubic spline regression relationship between frailty status and all-cause mortality, studies with three or more categories will be included. ETHICS AND DISSEMINATION: In accordance with the Institutional Review Board/Independent Ethics Committee of the First Affiliated Hospital of Baotou Medical College, ethical approval is not an essential element for the systematic review protocol. This meta-analysis will be disseminated through publication in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42020220226.

Optimal cut-off value of elevated cardiac troponin concentrations for myocardial injury predicts clinical outcomes in adult patients with COVID-19: a dose-response analysis protocol for systematic review.

INTRODUCTION: Acute myocardial injury in patients with COVID-19 infection has been recognised as one important complication associated with in-hospital mortality. The potential dose-response effect of cardiac troponin (cTn) concentrations on adverse clinical outcomes has not been systematically studied. Hence, we will conduct a comprehensive dose-response meta-analysis to quantitatively evaluate the relationship between elevated cTn concentrations and in-hospital adverse clinical outcomes in patients with COVID-19. METHODS: We will search PubMed, EMBASE, Cochrane Library and ISI Knowledge via Web of Science databases, as well as preprint databases (medRxiv and bioRxiv), from inception to October 2021, to identify all retrospective and prospective cohorts and randomised controlled studies using related keywords. The primary outcome will be all-cause mortality during hospitalisation. The secondary outcome will be major adverse event (MAE). To conduct a dose-response meta-analysis of the potential linear or restricted cubic spline regression relationship between elevated cTn concentrations and all-cause mortality or MAE, studies with three or more categories of cTn concentrations will be included. Univariable or multivariable meta-regression and subgroup analyses will be conducted to compare elevated and non-elevated categories of cTn concentration. Sensitivity analyses will be used to assess the robustness of our results by removing each included study at one time to obtain and evaluate the remaining overall estimates of all-cause mortality or MAE. ETHICS AND DISSEMINATION: In accordance with the Institutional Review Board/Independent Ethics Committee of Fuwai Hospital, ethical approval was waived for this systematic review protocol. This meta-analysis will be disseminated through a peer-reviewing process for journal publication and conference communication. PROSPERO REGISTRATION NUMBER: CRD42020216059.