Şiddetli Coronavirüs Hastalığı 2019 Olan Hastalarda Mortaliteyi Öngörmede Düzeltilmiş QT Aralığının Önemi
Öz
Giriş: Aralık 2019'da Çin'in Wuhan kentinde başlayan Coronavirus 2019 (COVID-19) hastalığı, kısa sürede ülkelerin sağlık ve ekonomik sistemlerini ciddi şekilde etkileyen bir pandemiye dönüştü. COVID-19, özellikle akciğer tutulumu ve kalp hasarı olan hastalarda ölüme neden olabilir. COVID-19 ile yoğun bakım ünitesine (YBÜ) kabul edilen hastalarda başlangıç repolarizasyon parametrelerinin prognostik bilgi sağlayıp sağlamadığını belirlemeyi amaçladık.
Yöntemler: Bu retrospektif kohort çalışmasına, YBÜ’de takip edilen ve doğrulanmış COVID-19'lu 135 yetişkin hastayı (ortanca yaş 61, %52 erkek, %51 hipertansiyon, %43 diabetes mellitus, %32 koroner arter hastalığı) dahil ettik. Hastaların verileri elektronik tıbbi kayıtlarından çıkarıldı ve hayatta kalanlar ile hayatta kalmayanlar arasında karşılaştırıldı.
Bulgular: 80'i taburcu olan hastaların takiplerinde 55'i hastanede öldü. Çok değişkenli lojistik regresyon analizi, kabulde düzeltilmiş QT aralığının (QTc) ≥457 msn'den uzun olduğunu gösterdi (olasılık oranı (OR) =6.433, %95 GA 1.539-26.970, p=0.01), 65 yaşından büyük (OR= 2.848, %95 GA: 1.003-8.091, p=0.04) ve 99 bpm'den yüksek kalp hızı (OR=9.180, %95 GA: 3.037-27.749, p=0.0001) hastanede mortalite için bağımsız risk faktörleriydi. Ayrıca düzeltilmiş T dalgasının sonuna kadar T dalga aralığı (Tpec) ölen hastalarda yaşayanlara göre istatistiksel olarak daha uzundu.
Sonuç: Başvuru, yaş ve kalp hızında ölçülen QTc değeri hastanede mortaliteyi tahmin etmeye yardımcı olabilir. Ayrıca Tpec, COVID-19 hastalarında ölüm riski hakkında bilgi verebilir.
Anahtar Kelimeler
koronavirüs hastalığı 2019 mortalite ventriküler repolarizasyon
Destekleyen Kurum
yok
Proje Numarası
yok
Teşekkür
yok
Kaynakça
- 1. Jee Y. WHO International Health Regulations Emergency Committee for the COVID-19 outbreak. Epidemiol Health. 2020;42:e2020013.
- 2. Shi S, Qin M, Shen B, et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiology 2020;5:802–10.
- 3. Guo T, Fan Y, Chen M, et al. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiol 2020;5:1–8.
- 4. Dherange P, Lang J, Qian P, et al. Arrhythmias and COVID-19: A review. JACC: Clinical Electrophysiology 2020 (6) 9; 1193-204.
- 5. Osadchii OE. Role of abnormal repolarization in the mechanism of cardiac arrhythmia. Acta Physiol (Oxf). 2017;220 Suppl 712:1-71.
- 6. Fabre A, Sheppard MN. Sudden adult death syndrome and other nonischaemic causes of sudden cardiac death. Heart. 2006;92(3):316-20.
- 7. Straus SM, Kors JA, De Bruin ML, et al. Prolonged QTc interval and risk of sudden cardiac death in a population of older adults. 2006;47(2):362-7.
- 8. Zabel M, Klingenheben T, Franz MR, Hohnloser SH. Assessment of QT dispersion for prediction of mortality or arrhythmic events after myocardial infarction: results of a prospective, long-term follow-up study. Circulation 1998;97:2543-50.
- 9. Rosenthal TM, Stahls III PF, Abi Samra FM, et al. T-peak to T-end interval for prediction of ventricular tachyarrhythmia and mortality in a primary prevention population with systolic cardiomyopathy. 2015;12(8):1789-97.
- 10. Shafi AM, Shaikh SA, Shirke MM, Iddawela S, Harky AJJocs. Cardiac manifestations in COVID‐19 patients—A systematic review. 2020;35(8):1988-2008.
- 11. Calvo-Fernández A, Izquierdo A, Subirana I, et al. Markers of myocardial injury in the prediction of short-term COVID-19 prognosis. Rev Esp Cardiol (Engl Ed). 2021 Jul;74(7):576-83.
- 12. Giudicessi, JR, Roden, DM, Wilde AA, Ackerman MJ. Genetic susceptibility for COVID-19–associated sudden cardiac death in African Americans. Heart rhythm 2020;9:1487-92.
- 13. Bazett HC. An analysis of the time relations of electrocardiograms. Heart. 1920;7:353-70.
- 14. Kochi AN, Tagliari AP, Forleo GB, Fassini GM, Tondo CJJoCE. Cardiac and arrhythmic complications in patients with COVID‐19. J Cardiovasc Electrophysiol 2020;31(5):1003-8.
- 15. Bertini M, Ferrari R, Guardigli G, et al. Electrocardiographic features of 431 consecutive, critically ill COVID-19 patients: an insight into the mechanisms of cardiac involvement. Europace. 2020;22(12):1848-54.
- 16. McCullough SA, Goyal P, Krishnan U, Choi JJ, Safford MM, Okin PM. Electrocardiographic Findings in Coronavirus Disease-19: Insights on Mortality and Underlying Myocardial Processes. J Card Fail. 2020;26(7):626-32.
- 17. Lazzerini PE, Boutjdir M, Capecchi PL. COVID19, arrhythmic risk and inflammation: mind the gap! Circulation 2020;142:7–9.
- 18. Tse G, Yeo JM, Chan YW, Lai ET, Yan BP. What Is the Arrhythmic Substrate in Viral Myocarditis? Insights from Clinical and Animal Studies. Front Physiol. 2016 Jul 21;7:308.
- 19. Lazzerini PE, Capecchi PL, Laghi-Pasini F. Long QT Syndrome: An Emerging Role for Inflammation and Immunity. Front Cardiovasc Med. 2015 May 27;2:26.
- 20. Karjalainen J, Viitasalo M. Fever and cardiac rhythm. Arch Intern Med. 1986;146(6):1169-71.
- 21. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13.
- 22. Zhao Z, Chen A, Hou W, et al. Prediction model and risk scores of ICU admission and mortality in COVID-19. PLoS One. 2020;15(7):e0236618.
- 23. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020 Mar 28;395(10229):1054-62.
- 24. Palaiodimos L, Kokkinidis DG, Li W, et al. Severe obesity, increasing age and male sex are independently associated with worse in-hospital outcomes, and higher in-hospital mortality, in a cohort of patients with COVID-19 in the Bronx, New York. Metabolism. 2020 Jul;108:154262.
- 25. Opal SM, Girard TD, Ely EW. The immunopathogenesis of sepsis in elderly patients. Clin Infect Dis. 2005 Nov 15;41 Suppl 7:S504-12.
- 26. Wilson PW, Castelli WP, Kannel WB. Coronary risk prediction in adults (the Framingham Heart Study). Am J Cardiol. 1987;59(14):91G-94G.
- 27. Mehra MR, Desai SS, Kuy S, Henry TD, Patel AN. Cardiovascular disease, drug therapy, and mortality in COVID-19. N Engl J Med. 2020; 382:e102.
- 28. Lippi G, Wong J, Henry Hypertension and its severity or mortality in Coronavirus Disease 2019 (COVID-19): a pooled analysis. Pol Arch Intern Med 2020;130(4):304-9.
- 29. Huang I, Lim MA, Pranata R. Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia - A systematic review, meta-analysis, and meta-regression. Diabetes Metab Syndr. 2020;14(4):395-403.
The Importance of Corrected QT Interval for Predicting of Mortality in Patients with Severe Coronavirus Disease 2019
Öz
Background: Coronavirus disease 2019 (COVID-19), which started in Wuhan, China in December 2019, soon turned into a pandemic that severely affected the countries ' health and economic systems. COVID-19 can lead to death, especially in patients with lung involvement and cardiac injury. We aimed to determine whether baseline repolarization parameters provide prognostic information in patients admitted to intensive care unit (ICU) with COVID-19.
Methods: In this retrospective cohort study, we included 135 adult patients (median age 61 years, 52% men, 51% hypertension, 43% diabetes mellitus, 32% coronary artery disease) with confirmed COVID-19 who were followed in the intensive care unit (ICU). Data of patients were extracted from the electrical medical records and compared between the survivors and the non-survivors.
Results: In follow-up, of whom 80 were discharged, 55 died in hospital. Multivariate logistic regression analysis showed that the corrected QT interval (QTc) longer than ≥457 msn on admission (odds ratio (OR) =6.433, 95% CI 1.539-26.970, p=0.01), the age older than 65 years (OR=2.848, 95% CI: 1.003-8.091, p=0.04) and heart rate greater than 99 bpm (OR=9.180, 95% CI: 3.037-27.749, p=0.0001) were independent risk factors for mortality in hospital. In addition, corrected the peak of T wave to the end of T wave interval (Tpec) was statistically longer in patients who died than those who lived.
Conclusion: The QTc value measured on admission, age and heart rate and can help to predict mortality in hospital. Additionally, Tpec can provide about the risk of mortality in COVID-19 patients.
Anahtar Kelimeler
coronavirus disease 2019 mortality ventricular repolarization
Proje Numarası
yok
Kaynakça
- 1. Jee Y. WHO International Health Regulations Emergency Committee for the COVID-19 outbreak. Epidemiol Health. 2020;42:e2020013.
- 2. Shi S, Qin M, Shen B, et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiology 2020;5:802–10.
- 3. Guo T, Fan Y, Chen M, et al. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiol 2020;5:1–8.
- 4. Dherange P, Lang J, Qian P, et al. Arrhythmias and COVID-19: A review. JACC: Clinical Electrophysiology 2020 (6) 9; 1193-204.
- 5. Osadchii OE. Role of abnormal repolarization in the mechanism of cardiac arrhythmia. Acta Physiol (Oxf). 2017;220 Suppl 712:1-71.
- 6. Fabre A, Sheppard MN. Sudden adult death syndrome and other nonischaemic causes of sudden cardiac death. Heart. 2006;92(3):316-20.
- 7. Straus SM, Kors JA, De Bruin ML, et al. Prolonged QTc interval and risk of sudden cardiac death in a population of older adults. 2006;47(2):362-7.
- 8. Zabel M, Klingenheben T, Franz MR, Hohnloser SH. Assessment of QT dispersion for prediction of mortality or arrhythmic events after myocardial infarction: results of a prospective, long-term follow-up study. Circulation 1998;97:2543-50.
- 9. Rosenthal TM, Stahls III PF, Abi Samra FM, et al. T-peak to T-end interval for prediction of ventricular tachyarrhythmia and mortality in a primary prevention population with systolic cardiomyopathy. 2015;12(8):1789-97.
- 10. Shafi AM, Shaikh SA, Shirke MM, Iddawela S, Harky AJJocs. Cardiac manifestations in COVID‐19 patients—A systematic review. 2020;35(8):1988-2008.
- 11. Calvo-Fernández A, Izquierdo A, Subirana I, et al. Markers of myocardial injury in the prediction of short-term COVID-19 prognosis. Rev Esp Cardiol (Engl Ed). 2021 Jul;74(7):576-83.
- 12. Giudicessi, JR, Roden, DM, Wilde AA, Ackerman MJ. Genetic susceptibility for COVID-19–associated sudden cardiac death in African Americans. Heart rhythm 2020;9:1487-92.
- 13. Bazett HC. An analysis of the time relations of electrocardiograms. Heart. 1920;7:353-70.
- 14. Kochi AN, Tagliari AP, Forleo GB, Fassini GM, Tondo CJJoCE. Cardiac and arrhythmic complications in patients with COVID‐19. J Cardiovasc Electrophysiol 2020;31(5):1003-8.
- 15. Bertini M, Ferrari R, Guardigli G, et al. Electrocardiographic features of 431 consecutive, critically ill COVID-19 patients: an insight into the mechanisms of cardiac involvement. Europace. 2020;22(12):1848-54.
- 16. McCullough SA, Goyal P, Krishnan U, Choi JJ, Safford MM, Okin PM. Electrocardiographic Findings in Coronavirus Disease-19: Insights on Mortality and Underlying Myocardial Processes. J Card Fail. 2020;26(7):626-32.
- 17. Lazzerini PE, Boutjdir M, Capecchi PL. COVID19, arrhythmic risk and inflammation: mind the gap! Circulation 2020;142:7–9.
- 18. Tse G, Yeo JM, Chan YW, Lai ET, Yan BP. What Is the Arrhythmic Substrate in Viral Myocarditis? Insights from Clinical and Animal Studies. Front Physiol. 2016 Jul 21;7:308.
- 19. Lazzerini PE, Capecchi PL, Laghi-Pasini F. Long QT Syndrome: An Emerging Role for Inflammation and Immunity. Front Cardiovasc Med. 2015 May 27;2:26.
- 20. Karjalainen J, Viitasalo M. Fever and cardiac rhythm. Arch Intern Med. 1986;146(6):1169-71.
- 21. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13.
- 22. Zhao Z, Chen A, Hou W, et al. Prediction model and risk scores of ICU admission and mortality in COVID-19. PLoS One. 2020;15(7):e0236618.
- 23. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020 Mar 28;395(10229):1054-62.
- 24. Palaiodimos L, Kokkinidis DG, Li W, et al. Severe obesity, increasing age and male sex are independently associated with worse in-hospital outcomes, and higher in-hospital mortality, in a cohort of patients with COVID-19 in the Bronx, New York. Metabolism. 2020 Jul;108:154262.
- 25. Opal SM, Girard TD, Ely EW. The immunopathogenesis of sepsis in elderly patients. Clin Infect Dis. 2005 Nov 15;41 Suppl 7:S504-12.
- 26. Wilson PW, Castelli WP, Kannel WB. Coronary risk prediction in adults (the Framingham Heart Study). Am J Cardiol. 1987;59(14):91G-94G.
- 27. Mehra MR, Desai SS, Kuy S, Henry TD, Patel AN. Cardiovascular disease, drug therapy, and mortality in COVID-19. N Engl J Med. 2020; 382:e102.
- 28. Lippi G, Wong J, Henry Hypertension and its severity or mortality in Coronavirus Disease 2019 (COVID-19): a pooled analysis. Pol Arch Intern Med 2020;130(4):304-9.
- 29. Huang I, Lim MA, Pranata R. Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia - A systematic review, meta-analysis, and meta-regression. Diabetes Metab Syndr. 2020;14(4):395-403.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Proje Numarası | yok |
| Yayımlanma Tarihi | 17 Kasım 2021 |
| Yayımlandığı Sayı | Yıl 2021 Cilt: 2 Sayı: 3 |
Kaynak Göster
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