Investigating prognostic value of cardiac biomarkers for predicting mortality in novel coronavirus disease-2019 patients: A meta-analysis of diagnostic test accuracy

ABSTRACT

Aims: Cardiac injury is common in novel coronavirus disease-2019 (COVID-19) patients and is associated with an increased risk of mortality. However, the prognostic accuracy of cardiac biomarkers in predicting mortality in COVID-19 patients remains unclear. A meta-analysis of diagnostic test accuracy was conducted to find cost-effective biomarkers, particularly those frequently evaluated to enable risk stratification and sensible resource allocation. Methods: We systematically searched PubMed, Europe PMC, and SCOPUS for studies published up to June 2021. Studies were enrolled, if they included assessment of the accuracy of predetermined cardiac biomarkers (troponin, lactate dehydrogenase (LDH), creatine kinase, and N-terminal pro-brain natriuretic peptide (NT-proBNP)) in predicting mortality of COVID-19 patients and provided sufficient data to construct a 2 x 2 contingency table. Results: This meta-analysis showed cardiac troponin was the most reliable biomarker in prognosticating mortality in COVID-19 patients (area under curve (AUC) = 0.79 (0.76-0.83), sensitivity = 0.63 (0.52-0.73), specificity = 0.80 (0.74-0.84)), followed by LDH (AUC = 0.75 (0.71-0.78), sensitivity = 0.72 (0.63-0.80), specificity = 0.65 (0.54-0.75)), NT-proBNP (AUC = 0.73 (0.69-0.77), sensitivity = 0.55 (0.41-0.68), specificity = 0.79 (0.68-0.87)), and creatine kinase (AUC = 0.35 (0.31-0.39), sensitivity = 0.27 (0.19-0.36), specificity = 0.76 (0.49-0.92)). Conclusion: Increased cardiac injury biomarkers may aid in the identification of individuals who are most at risk, especially cardiac troponin with AUC 0.79, 63% sensitivity and 80% specificity.