Department of Internal Medicine, Ascension St. John Hospital, Detroit, MI, USA.
Ann Noninvasive Electrocardiol. 2021 Sep;26(5):e12853. doi: 10.1111/anec.12853. Epub 2021 May 7.
2019 novel coronavirus (COVID-19) patients frequently develop QT interval prolongation that predisposes them to Torsades de Pointes and sudden cardiac death. Continuous cardiac monitoring has been recommended for any COVID-19 patient with a Tisdale Score of seven or more. This recommendation, however, has not been validated.
We included 178 COVID-19 patients admitted to a non-intensive care unit setting of a tertiary academic medical center. A receiver operating characteristics curve was plotted to determine the accuracy of the Tisdale Score to predict QT interval prolongation. Multivariable analysis was performed to identify additional predictors.
The area under the curve of the Tisdale Score was 0.60 (CI 95%, 0.46-0.75). Using the cutoff of seven to stratify COVID-19, patients had a sensitivity of 85.7% and a specificity of 7.6%. Risk factors independently associated with QT interval prolongation included a history of end-stage renal disease (ESRD) (OR, 6.42; CI 95%, 1.28-32.13), QTc ≥450 ms on admission (OR, 5.90; CI 95%, 1.62-21.50), and serum potassium ≤3.5 mmol/L during hospitalization (OR, 4.97; CI 95%, 1.51-16.36).
The Tisdale Score is not a useful tool to stratify hospitalized non-critical COVID-19 patients based on their risks of developing QT interval prolongation. Clinicians should initiate continuous cardiac monitoring for patients who present with a history of ESRD, QTc ≥450 ms on admission or serum potassium ≤3.5 mmol/L.
2019 年新型冠状病毒（COVID-19）患者常出现 QT 间期延长，这使他们容易发生尖端扭转型室性心动过速和心源性猝死。对于 Tisdale 评分≥7 分的任何 COVID-19 患者，都建议进行连续心脏监测。然而，这一建议尚未得到验证。
我们纳入了在一所三级学术医疗中心的非重症监护病房环境中收治的 178 例 COVID-19 患者。绘制了受试者工作特征曲线，以确定 Tisdale 评分预测 QT 间期延长的准确性。进行多变量分析以确定其他预测因素。
Tisdale 评分的曲线下面积为 0.60（95%CI，0.46-0.75）。使用 7 分作为 COVID-19 的分层截止值，患者的敏感性为 85.7%，特异性为 7.6%。与 QT 间期延长独立相关的危险因素包括终末期肾病（ESRD）病史（OR，6.42；95%CI，1.28-32.13）、入院时 QTc≥450ms（OR，5.90；95%CI，1.62-21.50）和住院期间血清钾≤3.5mmol/L（OR，4.97；95%CI，1.51-16.36）。
Tisdale 评分不能作为依据，用于对住院非重症 COVID-19 患者进行分层，以评估其发生 QT 间期延长的风险。对于存在 ESRD 病史、入院时 QTc≥450ms 或血清钾≤3.5mmol/L 的患者，临床医生应开始进行连续心脏监测。
