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Cardiovascular medicine
Protocol
Optimal cut-off value of elevated cardiac troponin concentrations for myocardial injury predicts clinical outcomes in adult patients with COVID-19: a dose–response analysis protocol for systematic review
  1. Chenghui Zhou1,
  2. Hanjun Pei2,
  3. Yiming Gao3,
  4. Yulin Zhang1,
  5. Liang Cao1,
  6. Zhongrong Fang1,
  7. Jiangping Song4
  1. 1Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  2. 2Department of Cardiology, First Affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia, China
  3. 3Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
  4. 4Department of Cardiac Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  1. Correspondence to Dr Chenghui Zhou; chenghuizhou{at}yahoo.com; Dr Jiangping Song; fwsongjiangping{at}126.com

Abstract

Introduction Acute myocardial injury in patients with COVID-19 infection has been recognised as one important complication associated with in-hospital mortality. The potential dose–response effect of cardiac troponin (cTn) concentrations on adverse clinical outcomes has not been systematically studied. Hence, we will conduct a comprehensive dose–response meta-analysis to quantitatively evaluate the relationship between elevated cTn concentrations and in-hospital adverse clinical outcomes in patients with COVID-19.

Methods We will search PubMed, EMBASE, Cochrane Library and ISI Knowledge via Web of Science databases, as well as preprint databases (medRxiv and bioRxiv), from inception to October 2021, to identify all retrospective and prospective cohorts and randomised controlled studies using related keywords. The primary outcome will be all-cause mortality during hospitalisation. The secondary outcome will be major adverse event (MAE). To conduct a dose–response meta-analysis of the potential linear or restricted cubic spline regression relationship between elevated cTn concentrations and all-cause mortality or MAE, studies with three or more categories of cTn concentrations will be included. Univariable or multivariable meta-regression and subgroup analyses will be conducted to compare elevated and non-elevated categories of cTn concentration. Sensitivity analyses will be used to assess the robustness of our results by removing each included study at one time to obtain and evaluate the remaining overall estimates of all-cause mortality or MAE.

Ethics and dissemination In accordance with the Institutional Review Board/Independent Ethics Committee of Fuwai Hospital, ethical approval was waived for this systematic review protocol. This meta-analysis will be disseminated through a peer-reviewing process for journal publication and conference communication.

PROSPERO registration number CRD42020216059.

  • adult intensive & critical care
  • adult cardiology
  • myocardial infarction
  • COVID-19
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2020-046575

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    Footnotes

    • CZ and JS are joint senior authors.

    • CZ and HP are joint first authors.

    • Contributors CZ, HP and JS contributed to the conception and design of the study and revision of the protocol. The manuscript was drafted by CZ. YG and YZ will independently search and select the eligible studies and extract the data from the included studies. LC and ZF will assess the methodological quality and the risk of bias. All authors approved the protocol publication.

    • Funding This work was supported by the Chinese Academy of Medical Sciences (CAMS) Initiative for Innovative Medicine (2020-I2M-CoV19-003), and the National Natural Science Foundation of China (no. 81970290 and no. 81760096).

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.