Mahdi Mohammed, Bezawada Vineel, Ozer Muhammet, De Deyne Patrick, Nagra Bipinpreet, Kantharia Bharat
Internal Medicine, Capital Health Regional Medical Center, Trenton, USA.
Clinical Research, Capital Health Regional Medical Center, Trenton, USA.
Cureus. 2021 Dec 18;13(12):e20507. doi: 10.7759/cureus.20507. eCollection 2021 Dec.
Background Cardiac arrhythmia is one of the life-threatening cardiovascular complications commonly reported in patients hospitalized with coronavirus disease 2019 (COVID-19). We aimed to evaluate the association between cardiac arrhythmias and disease severity based on oxygen requirement. Methods In this retrospective observational chart review-based study we recruited 396 patients hospitalized with COVID-19 from March 2020 to May 2020 from two regional medical centers in New Jersey, USA. Patients' baseline characteristics, secondary diagnoses, and laboratory findings were manually extracted and compared among two groups: patients with cardiac arrhythmias and those without. Poisson regression analysis was used to evaluate the correlation of cardiac arrhythmias and increased oxygen requirement, which are: room air (RA), nasal cannula (NC), high flow nasal cannula (HFNC), and bi-level positive airway pressure ventilation or invasive mechanical ventilation (BIPAP/MV). Results The demographic characteristics of the patients were: aged 61 +/- 18.7 years (mean +/- standard deviation); with 56% being male, and 44.9% of African American race. There were 16% patients on RA, 40% on NC, 15% on HFNC, and 29% on BIPAP/MV. The incidence of cardiac arrhythmias was 36.7% (20% pulseless electrical activity (PEA), 13.5% atrial fibrillation (AF). 56% of AF was new-onset arrhythmia. Compared to the RA group, the risk of cardiac arrhythmias was significantly higher in BIPAP/MV (OR 3.3; 95% CI 1.8 - 6.2, p <0.001) and HFNC (OR 2.9; 95% CI 1.5-5.7, p0.001), but not in NC group (OR 0.95; 95% CI 0.4-1.8, p0.89). Compared to patients without arrhythmias, patients with arrhythmias were older (mean age 71 vs. 56 years, p <0.001) and had more comorbidities (Charlson comorbidity index (CCI), 4.7 vs. 2.9, p <0.001). The continued therapy of angiotensin-converting enzyme inhibitors or angiotensin-II receptor blockers did not seem to be associated with increased or decreased risk of cardiac arrhythmias. Conclusion The incidence of cardiac arrhythmias among hospitalized COVID-19 patients was 36.7% with PEA being common in patients who succumbed to death, and AF in those patients who survived. The incidence of cardiac arrhythmias positively correlated with disease severity based on oxygen requirement and was higher among patients requiring HFNC or BIPAP/MV.
心律失常是新型冠状病毒肺炎（COVID-19）住院患者中常见的危及生命的心血管并发症之一。我们旨在基于氧需求评估心律失常与疾病严重程度之间的关联。方法：在这项基于回顾性观察图表审查的研究中，我们从美国新泽西州的两个地区医疗中心招募了2020年3月至2020年5月期间因COVID-19住院的396例患者。人工提取患者的基线特征、二级诊断和实验室检查结果，并在两组之间进行比较：有心律失常的患者和无心律失常的患者。采用泊松回归分析评估心律失常与氧需求增加之间的相关性，氧需求增加的情况包括：室内空气（RA）、鼻导管吸氧（NC）、高流量鼻导管吸氧（HFNC）以及双水平气道正压通气或有创机械通气（BIPAP/MV）。结果：患者的人口统计学特征为：年龄61±18.7岁（均值±标准差）；男性占56%，非裔美国人占44.9%。16%的患者采用室内空气吸氧，40%采用鼻导管吸氧，15%采用高流量鼻导管吸氧，29%采用双水平气道正压通气或有创机械通气。心律失常的发生率为36.7%（20%为无脉电活动（PEA），13.5%为心房颤动（AF）。AF的56%为新发心律失常。与RA组相比，BIPAP/MV组（OR 3.3；95%CI 1.8 - 6.2，p<0.001）和HFNC组（OR 2.9；95%CI 1.5 - 5.7，p0.001）心律失常的风险显著更高，但NC组（OR 0.95；95%CI 0.4 - 1.8，p0.89）并非如此。与没有心律失常的患者相比，有心律失常的患者年龄更大（平均年龄71岁对56岁，p<0.001）且合并症更多（Charlson合并症指数（CCI），4.7对2.9，p<0.001）。血管紧张素转换酶抑制剂或血管紧张素II受体阻滞剂的持续治疗似乎与心律失常风险的增加或降低无关。结论：COVID-19住院患者中心律失常的发生率为36.7%，PEA在死亡患者中常见，AF在存活患者中常见。心律失常的发生率与基于氧需求的疾病严重程度呈正相关，在需要HFNC或BIPAP/MV的患者中更高。
