危重型新型冠状病毒肺炎患者心肌肌钙蛋白及D-二聚体水平与病死率的Meta分析

Correlation between cardiac troponin and D-dimer levels and mortality in COVID-19 critical illness patients:A meta analysis

目的评价危重型新型冠状病毒肺炎(COVID-19)患者心肌肌钙蛋白(cTn)及D-二聚体(D-D)水平与病死率的相关性。方法检索PubMed、万方期刊数据库、中国知网、维普中文科技期刊数据库等,搜集以COVID-19与cTn为主题的相关研究。检索时限均为2020年1月1日-2021年12月31日。由2名评价员独立筛选文献、提取资料,采用RevMan 5.3软件进行Meta分析,结果用RR及其95%CI表示。结果纳入分析的文献为15篇,纽卡斯尔-渥太华质量评估量表(NOS)评分均≥6分,涉及患者7290例,均为确诊的危重型COVID-19住院患者,死亡组1820例,存活组5470例。Meta分析结果显示,cTn水平升高的COVID-19患者病死率更高(RR=3.13,95%CI=2.13-4.62,Z=5.76,P<0.01),D-D水平升高的COVID-19患者病死率也较高,差异有统计学意义(RR=1.69,95%CI=1.27-2.26,Z=3.60,P=0.0003)。性别亚组分析的结果显示COVID-19死亡患者中男性居多,表明COVID-19男性患者的病死率更高(P<0.01)。结论cTn及D-D水平升高的危重型COVID-19患者更易死亡,cTn及D-D与危重型COVID-19患者的病死率具有相关性。

Objective To evaluate the correlation between cardiac troponin(cTn)and D-dimer(D-D)levels and mortality in coronavirus disease 2019(COVID-19)critical illness patients.Methods We searched related researches using COVID-19 and cTn as keyword in PubMed,Wanfang Journal Database,CNKI,VIP Chinese Scientific and Technological Periodical Database(VIP),etc.,the period is from January 1,2020 to December 31,2021.Two reviewers independently conducted this work.We performed Meta-analysis using RevMan5.3 software,and the results were expressed as relative risk(RR)and its 95%confidence interval(CI).Results There were eligible15 literatures in the analysis,the Newcastle-Ottawa Quality Assessment Scale(NOS)scores were≥6,and involving 7290 inpatients with COVID-19 critical illness,of which 1820 as the death group and 5470 as the survival group.Meta-analysis results showed that both elevated cTn level(RR=3.13,95%CI=2.13-4.62,Z=5.76,P<0.01)and up-regulated D-D level(RR=1.69,95%CI=1.27-2.26,Z=3.60,P=0.0003)of COVID-19 patients had obviously higher mortality.The results of gender subgroup analysis indicated that the mortality of COVID-19 male patients was more prevalent(P<0.01).Conclusion For COVID-19 critical illness patients,both elevated cTn level and up-regulation D-D level are more likely to rise mortality.