Related Experiment Video
Updated: Jun 18, 2025
Author Spotlight: A Unique Mouse Model of Asphyxia-Induced Cardiac Arrest
Published on: April 14, 2023
Cardiac Injury in COVID-19: A Systematic Review of Relevant Meta-Analyses
Konstantinos G Kyriakoulis1, Ioannis G Kyriakoulis1, Ioannis P Trontzas1
1National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, 11527 Athens, Greece.
Insights
Cardiac injury (CI) is a common complication in hospitalized COVID-19 patients. This systematic review highlights that CI significantly increases the risk of severe illness and mortality, despite methodological limitations in existing meta-analyses.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Cardiac injury (CI) is a frequent occurrence in hospitalized patients diagnosed with coronavirus disease 2019 (COVID-19).
- The prognostic implications of CI have been extensively documented in observational studies, leading to numerous meta-analyses.
- While meta-analyses show consistent findings, methodological challenges warrant consideration.
Purpose of the Study:
- To systematically identify and review meta-analyses concerning the incidence of CI in COVID-19 patients.
- To evaluate the prognostic value of CI in hospitalized COVID-19 patients.
- To synthesize findings on the association between CI and COVID-19 severity and mortality.
Main Methods:
- A systematic literature search was performed to find relevant meta-analyses.
- Included meta-analyses focused on the incidence and prognostic value of CI in hospitalized COVID-19 patients.
- Data from 73 meta-analyses were analyzed, assessing CI definitions, incidence rates, and associations with clinical outcomes.
Main Results:
- The pooled incidence of CI in hospitalized COVID-19 patients varied from 5% to 37%, with troponin being the most common biomarker used for definition.
- A significant association between CI and increased COVID-19 infection severity was reported in most meta-analyses (26 out of 32).
- Forty-six meta-analyses demonstrated that CI is linked to a higher risk of mortality in COVID-19 patients, with pooled adjusted hazard ratios for death ranging from 1.5 to 3.
Conclusions:
- Cardiac injury significantly worsens the prognosis for hospitalized COVID-19 patients.
- Methodological limitations in existing meta-analyses, including non-peer-reviewed studies and unadjusted analyses, require careful consideration.
- Despite limitations, the adverse prognostic impact of CI in COVID-19 is consistently supported by the evidence.
Background:
Cardiac injury (CI) is not a rare condition among hospitalized patients with coronavirus disease 2019 (COVID-19). Its prognostic value has been extensively reported through the literature, mainly in the context of observational studies. An impressive number of relevant meta-analyses has been conducted. These meta-analyses present similar and consistent results; yet interesting methodological issues emerge.
Methods:
A systematic literature search was conducted aiming to identify all relevant meta-analyses on (i) the incidence, and (ii) the prognostic value of CI among hospitalized patients with COVID-19.
Results:
Among 118 articles initially retrieved, 73 fulfilled the inclusion criteria and were included in the systematic review. Various criteria were used for CI definition mainly based on elevated cardiac biomarkers levels. The most frequently used biomarker was troponin. 30 meta-analyses reported the pooled incidence of CI in hospitalized patients with COVID-19 that varies from 5% to 37%. 32 meta-analyses reported on the association of CI with COVID-19 infection severity, with only 6 of them failing to show a statistically significant association. Finally, 46 meta-analyses investigated the association of CI with mortality and showed that patients with COVID-19 with CI had increased risk for worse prognosis. Four meta-analyses reported pooled adjusted hazard ratios for death in patients with COVID-19 and CI vs those without CI ranging from 1.5 to 3.
Conclusions:
The impact of CI on the prognosis of hospitalized patients with COVID-19 has gained great interest during the pandemic. Methodological issues such as the inclusion of not peer-reviewed studies, the inclusion of potentially overlapping populations or the inclusion of studies with unadjusted analyses for confounders should be taken into consideration. Despite these limitations, the adverse prognosis of patients with COVID-19 and CI has been consistently demonstrated.
