严重急性呼吸综合征冠状病毒 2 感染危重症患者的 QT 间期延长。
QT Prolongation in Critically Ill Patients With SARS-CoV-2 Infection.
机构信息
284697Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
284697Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
出版信息
J Cardiovasc Pharmacol Ther. 2022 Jan-Dec;27:10742484211069479. doi: 10.1177/10742484211069479.
BACKGROUND
Several reports linked the use of repurposed drugs such as hydroxychloroquine (HCQ), azithromycin, lopinavir/ritonavir, and favipiravir with QT interval prolongation in patients with SARS-CoV2 infection. Little is known about the risk factors for QT interval prolongation in this population. We sought to describe the prevalence and identify the main risk factors associated with clinically significant corrected QT (QTc) prolongation in this population.
METHODS
We conducted a retrospective analysis of critically ill patients who were admitted to our intensive care unit (ICU), had at least one electrocardiogram performed during their ICU stay, and tested positive for SARs-CoV-2. Clinically significant QTc interval prolongation was defined as QTc >500 milliseconds (ms).
RESULTS
Out of the 111 critically ill patients with SARS-CoV-2 infection, QTc was significantly prolonged in 47 cases (42.3%). Patients with a clinically significant QTc prolongation had significantly higher proportions of history of cardiac diseases/surgery (22 [46.8%] vs. 10 [15.6%], < .001), hypokalemia (10 [21.3] vs. 5 [7.8%], = .04), and male gender (95% vs. 82.8%, = .036) than patients with QTc ≤500 ms, respectively. A total of 46 patients (41.4%) received HCQ, 28 (25.2%) received lopinavir/ritonavir, and 5 (4.5%) received azithromycin. Multivariate logistic regression analysis showed that a history of cardiac disease was the only independent factor associated with clinically significant QTc prolongation ( = .004 for the likelihood-ratio test).
CONCLUSION
The prevalence of clinically significant QTc prolongation in critically ill patients with SARS-CoV-2 infection was high and independent of drugs used. Larger prospective observational studies are warranted to elucidate independent risk factors associated with clinically significant QTc prolongation in this study population.
背景
几项报告将羟氯喹（HCQ）、阿奇霉素、洛匹那韦/利托那韦和法匹拉韦等重新利用的药物与 SARS-CoV2 感染患者的 QT 间期延长联系起来。关于该人群 QT 间期延长的危险因素知之甚少。我们旨在描述该人群中 QT 间期延长的流行率，并确定与临床显著校正 QT（QTc）延长相关的主要危险因素。
方法
我们对入住我们重症监护病房（ICU）且 ICU 期间至少进行过一次心电图检查且 SARS-CoV-2 检测呈阳性的危重症患者进行了回顾性分析。QTc 间期延长定义为 QTc>500 毫秒（ms）。
结果
在 111 例 SARS-CoV-2 感染的危重症患者中，47 例（42.3%）的 QTc 显著延长。与 QTc≤500ms 的患者相比，具有临床显著 QTc 延长的患者具有更高比例的心脏病/手术史（22[46.8%] vs. 10[15.6%]，<0.001）、低钾血症（10[21.3%] vs. 5[7.8%]，=0.04）和男性（95% vs. 82.8%，=0.036）。共有 46 例（41.4%）患者接受 HCQ、28 例（25.2%）患者接受洛匹那韦/利托那韦、5 例（4.5%）患者接受阿奇霉素。多变量逻辑回归分析表明，心脏病史是与临床显著 QTc 延长唯一相关的独立因素（似然比检验=0.004）。
结论
在 SARS-CoV-2 感染的危重症患者中，临床显著 QTc 延长的发生率较高，且与药物无关。需要更大规模的前瞻性观察性研究来阐明与该研究人群临床显著 QTc 延长相关的独立危险因素。
Zotero 插件