Troponin I biomarker as a strong prognostic factor for predicting COVID-19 mortality:A systematic review

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 diseaserelated 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.

Hydroxychloroquine alone or in combination with azithromycin and corrected QT prolongation in COVID-19 patients:A systematic review

BACKGROUND Despite the controversies about the effectiveness of the current drug regimens for coronavirus disease 2019(COVID-19),these drugs are still the only options available.Moreover,the safety of these drugs is yet to be confirmed.A serious concern is the occurrence of various cardiac arrhythmias,particularly QT prolongation.AIM To summarize the incidence and estimate the risk of QT interval prolongation in patients scheduling for conventional treatment(hydroxychloroquine alone or in combination with azithromycin)for COVID-19.METHODS We comprehensively searched Medline,Web of Knowledge,Google Scholar,Scopus,and Cochrane Central Register of Controlled Trials databases until October 31,2020 for all eligible studies under the considered keywords COVID19,arrhythmia,QT interval,therapy,azithromycin,and hydroxychloroquine until.The study protocols were established in compliance with PRISMA-P guidelines(Preferred Reporting Items for Systematic Review and Meta-Analysis–Protocols),and a nine-star Newcastle-Ottawa Scale scoring system was used to assess the methodological quality of all eligible studies.Outcome measures were corrected QT(QTc)prolongation,cardiac arrhythmias,or sudden cardiac death.RESULTS Fifteen studies enrolling 8298 patients with targeted COVID-19 therapeutic regimes were included.The eligible studies found a significant increase in the mean QTc interval following treatment with the described medications compared to baseline QTc with weighted standard differences in means of 0.766.The pooled prevalence rate of QTc prolongation was estimated to be 9.2%(95%confidence interval:4.5%to 18.1%).CONCLUSION Hydroxychloroquine±azithromycin regimen can significantly increase the risk of developing QTc prolongation.