Abstract
Objectives: We conducted a systematic review and meta-analysis with meta-regression of creatine kinase-MB (CK-MB), a biomarker of myocardial injury, in COVID-19 patients.
Methods: We searched PubMed, Web of Science and Scopus, for studies published between January 2020 and January 2021 that reported CK-MB, COVID-19 severity and mortality (PROSPERO registration number: CRD42021239657).
Results: Fifty-five studies in 11,791 COVID-19 patients were included in the meta-analysis. The pooled results showed that CK-MB concentrations were significantly higher in patients with high disease severity or non-survivor status than patients with low severity or survivor status (standardized mean difference, SMD, 0.81, 95% CI 0.61 to 1.01, p<0.001). The rate of patients with CK-MB values above the normal range was also significantly higher in the former than the latter (60/350 vs 98/1,780; RR = 2.84, 95%CI 1.89 to 4.27, p<0.001; I 2 = 19.9, p = 0.254). Extreme between-study heterogeneity was observed (I 2 = 93.4%, p<0.001). Sensitivity analysis, performed by sequentially removing each study and re-assessing the pooled estimates, showed that the magnitude and direction of the effect size was not modified (effect size range, 0.77 to 0.84). Begg’s (p = 0.50) and Egger’s (p = 0.86) t-tests did not show publication bias. In meta-regression analysis, the SMD was significantly and positively associated with the white blood count, aspartate aminotransferase, myoglobin, troponin, brain natriuretic peptide, lactate dehydrogenase, and D-dimer.
Conclusions: Higher CK-MB concentrations were significantly associated with severe disease and mortality in COVID-19 patients. This biomarker of myocardial injury might be useful for risk stratification in this group.
Keywords: COVID-19; Creatine kinase-MB; Creatine kinase-MB values Above the normal range; Disease severity; Mortality.
【저자키워드】 COVID-19, Mortality, disease severity, Creatine kinase-MB, Creatine kinase-MB values Above the normal range, 【초록키워드】 Meta-analysis, Biomarker, Mortality, severity, disease severity, creatine, COVID-19 severity, peptide, systematic review, D-dimer, troponin, lactate dehydrogenase, heterogeneity, publication bias, meta-regression, Brain, risk stratification, myocardial injury, Patient, Aspartate aminotransferase, sensitivity analysis, creatine kinase, estimates, COVID-19 patients, Blood, Myoglobin, Creatine kinase-MB, blood count, Lactate, Concentration, Analysis, severe disease, COVID-19 patient, registration number, normal range, brain natriuretic peptide, Web of Science, 95%CI, CK-MB, standardized mean difference, 95% CI, t-test, aspartate, effect size, study heterogeneity, direction, survivor, T-tests, SMD, non-survivor, performed, significantly, reported, conducted, searched, magnitude, significantly higher, Above, Egger,