Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Medicina (Kaunas). 2022 Jul 19;58(7):950. doi: 10.3390/medicina58070950.
Background and Objective: Bradycardia has been observed among patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is suspected to be associated with poorer outcomes. Heart rate (HR) fluctuation has been found to be correlated with a greater mortality rate in critically ill patients. The association of bradycardia and HR fluctuation with the outcome of severe coronavirus disease 2019 (COVID-19) patients has not been clarified. Therefore, we aimed to examine whether bradycardia and HR fluctuation correlated with poor outcomes in patients with severe COVID-19. Materials and Methods: We conducted a secondary analysis from a prospective data collection of patients admitted to the intensive care unit, between April and June 2021, at Chiang Mai University Hospital. Results: The results showed that 62 of 86 patients (72.1%) had bradycardia, defined by HR < 60 beats per minute (bpm). The number of patients with high HR fluctuation, defined as the difference in HR during admission ≥ 40 bpm, was greater among the bradycardia group than in the non-bradycardia group (70.9% vs. 14.7%, p = 0.015, respectively). The patients with bradycardia had greater levels of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). In addition, a greater proportion of patients with bradycardia received interleukin-6 inhibitors and hemoperfusion as a rescue therapy than those with non-bradycardia. After adjusting for age, gender, body mass index, CRP, and mechanical ventilator; bradycardia and the high HR fluctuation were significantly associated with a longer length of stay in the intensive care unit (ICU-LOS), with adjusted risk ratios of 2.67, 95% CI; 1.02, 6.94, p = 0.045 and 2.88, 95% CI; 1.22, 6.78, p = 0.016, respectively. Conclusion: We found that bradycardia and a high heart rate fluctuation were associated with a poorer ICU outcome in terms of longer ICU-LOS among the patients with severe COVID-19.
患有严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）的患者出现心动过缓，且怀疑与较差的预后相关。有研究发现，危重症患者的心率波动与死亡率升高相关。严重 2019 冠状病毒病（COVID-19）患者的心动过缓与心率波动与结局的相关性尚未明确。因此，我们旨在研究严重 COVID-19 患者的心动过缓与心率波动是否与不良预后相关。材料与方法：我们对 2021 年 4 月至 6 月期间在清迈大学医院重症监护病房住院的患者进行了前瞻性数据采集，并进行了二次分析。结果：结果显示，86 例患者中 62 例（72.1%）存在心动过缓，定义为心率＜60 次/分钟（bpm）。心动过缓组的高心率波动患者比例（定义为入院时心率差异≥40 bpm）高于非心动过缓组（分别为 70.9%和 14.7%，p=0.015）。心动过缓患者的红细胞沉降率（ESR）和 C 反应蛋白（CRP）水平更高。此外，与非心动过缓患者相比，心动过缓患者接受白细胞介素 6 抑制剂和血液灌流作为抢救治疗的比例更高。在校正年龄、性别、体重指数、CRP 和机械通气后；心动过缓和高心率波动与 ICU 住院时间（ICU-LOS）延长显著相关，调整后的风险比分别为 2.67、95%CI；1.02，6.94，p=0.045 和 2.88、95%CI；1.22，6.78，p=0.016。结论：我们发现，严重 COVID-19 患者中，心动过缓和高心率波动与 ICU 结局较差相关，表现为 ICU-LOS 延长。
