Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Rheumatology Unit Sapienza University of Rome, Italy.
Dipartimento di Scienze Cardiovascolari e Respiratorie, Sapienza University of Rome, Italy.
Clin Exp Rheumatol. 2022 May;40(5):890-896. doi: 10.55563/clinexprheumatol/7ullgb. Epub 2022 Mar 30.
Antimalarials have been associated with QT prolongation in COVID-19 patients but are generally safe in systemic lupus erythematosus (SLE).We compared the prevalence of QTc prolongation between COVID-19 and SLE patients treated with hydroxychloroquine (HCQ).
We included patients with SARS-CoV-2 infection confirmed by nasopharyngeal swab and patients taking HCQ for SLE. A prolonged QTc was defined as an increase in QTc intervals >60 ms (compared with baseline) or as a QTc of ≥500 ms. We performed the univariate and multivariate logistic regression to investigate the risk factors for QTc prolongation in COVID-19 patients.
We enrolled 58 COVID-19 patients (median age 70.5 years, IQR 25), grouped into group A (patients with HCQ) group B (patients with HCQ + azithromycin) and group C (not received either drug). Fifty (26%) COVID-19 patients presented a QTc prolongation (12 QTc≥500 ms, 3 patients ΔQTc>60 ms). We did not find any differences in QTc prolongation among the three treatment groups. Baseline QTc (OR 111.5) and D-dimer (OR 78.3) were independently associated to QTc prolongation. Compared to the 50 SLE patients (median age 38.5 years, IQR 22), chronically treated with HCQ, COVID-19 patients showed significantly longer QTc (p<0.001).
This is the first study demonstrating that, unlike COVID-19 patients, patients with SLE are not susceptible to HCQ-induced long QT syndrome and arrhythmia. The combined arrhythmogenic effect of SARS-CoV-2 infection and HCQ could account for the excess of QTc prolongation and fatal arrhythmias described in patients with COVID-19.
抗疟药物与 COVID-19 患者的 QT 延长有关，但在系统性红斑狼疮 (SLE) 中通常是安全的。我们比较了 COVID-19 和接受羟氯喹 (HCQ) 治疗的 SLE 患者中 QTc 延长的发生率。
我们纳入了经鼻咽拭子确诊 SARS-CoV-2 感染的患者和接受 HCQ 治疗 SLE 的患者。QTc 延长定义为 QTc 间期较基线增加 >60ms（或 QTc≥500ms）。我们进行了单变量和多变量逻辑回归分析，以探讨 COVID-19 患者 QTc 延长的危险因素。
我们共纳入了 58 例 COVID-19 患者（中位年龄 70.5 岁，IQR 25），分为 A 组（接受 HCQ 治疗的患者）、B 组（接受 HCQ+阿奇霉素治疗的患者）和 C 组（未接受两种药物治疗的患者）。50 例（26%）COVID-19 患者出现 QTc 延长（12 例 QTc≥500ms，3 例 ΔQTc>60ms）。三组患者的 QTc 延长率无差异。基线 QTc（OR 111.5）和 D-二聚体（OR 78.3）与 QTc 延长独立相关。与长期接受 HCQ 治疗的 50 例 SLE 患者（中位年龄 38.5 岁，IQR 22）相比，COVID-19 患者的 QTc 显著延长（p<0.001）。
这是第一项表明 COVID-19 患者与 SLE 患者不同，不会受到 HCQ 诱导的长 QT 综合征和心律失常影响的研究。SARS-CoV-2 感染和 HCQ 的联合致心律失常作用可能解释了 COVID-19 患者描述的 QTc 延长和致命性心律失常增加。
