Internal Medicine Department, Shaare Zedek Medical Center, School of Medicine, Hebrew University, Jerusalem, Israel.
Faculty of Medicine, Hebrew University, Jerusalem, Israel.
Int J Clin Pract. 2021 Mar;75(3):e13767. doi: 10.1111/ijcp.13767. Epub 2020 Dec 18.
The liberal administration of hydroxychloroquine-sulphate (HCQ) to COVID-19 patients has raised concern regarding the risk of QTc prolongation and cardiac arrhythmias, particularly when prescribed with azithromycin. We evaluated the incidence of QTc prolongation among moderately and severely ill COVID-19 patients treated with HCQ and of the existence of concomitant alternative causes.
All COVID-19 patients treated with HCQ (between Mar 1 and Apr 14, 2020) in a tertiary medical centre were included. Clinical characteristics and relevant risk factors were collected from the electronic medical records. Individual patient QTc intervals were determined before and after treatment with HCQ. The primary outcome measure sought was a composite end point comprised of either an increase ≥60 milliseconds (ms) in the QTc interval compared with pre-treatment QTc, and/or a maximal QTc interval >500 ms RESULTS: Ninety patients were included. Median age was 65 years (IQR 55-75) and 57 (63%) were male. Thirty-nine patients (43%) were severely or critically ill. Hypertension and obesity were common (n = 23 each, 26%). QTc prolongation evolved in 14 patients (16%). Age >65 years, congestive heart failure, severity of disease, C-reactive protein level, hypokalaemia and furosemide treatment, were all associated with QTc prolongation. Adjusted analysis showed that QTc prolongation was five times more likely with hypokalaemia [OR 5, (95% CI, 1.3-20)], and three times more likely with furosemide treatment [OR 3 (95% CI, 1.01-13.7)].
In patients treated with HCQ, QTc prolongation was associated with the presence of traditional risk factors such as hypokalaemia and furosemide treatment.
羟氯喹硫酸盐（HCQ）在 COVID-19 患者中的广泛应用引起了人们对 QTc 延长和心律失常风险的关注，尤其是与阿奇霉素联合使用时。我们评估了在使用 HCQ 治疗的中度和重度 COVID-19 患者中 QTc 延长的发生率，以及是否存在伴随的其他原因。
我们纳入了 2020 年 3 月 1 日至 4 月 14 日期间在一家三级医疗中心接受 HCQ 治疗的所有 COVID-19 患者。从电子病历中收集临床特征和相关危险因素。在接受 HCQ 治疗前后确定个体患者的 QTc 间期。主要终点是由 QTc 间期较治疗前增加≥60 毫秒（ms）和/或最大 QTc 间期>500 ms 组成的复合终点。
共纳入 90 例患者。中位年龄为 65 岁（IQR 55-75），57 例（63%）为男性。39 例（43%）患者病情严重或危急。高血压和肥胖很常见（各 23 例，占 26%）。14 例患者（16%）出现 QTc 延长。年龄>65 岁、充血性心力衰竭、疾病严重程度、C 反应蛋白水平、低钾血症和呋塞米治疗均与 QTc 延长有关。调整分析显示，低钾血症使 QTc 延长的可能性增加 5 倍[比值比 5（95%置信区间，1.3-20）]，呋塞米治疗使 QTc 延长的可能性增加 3 倍[比值比 3（95%置信区间，1.01-13.7）]。
在接受 HCQ 治疗的患者中，QTc 延长与低钾血症和呋塞米治疗等传统危险因素有关。
