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Predictive factors for cardiac conduction abnormalities with hydroxychloroquine-containing combinations for COVID-19
This longitudinal, prospective cohort study aimed to assess risk of QTc interval prolongation and its predicting factors in subjects treated with combinations containing hydroxychloroquine (HCQ) for COVID-19. Moderate-to-severe QTc prolongation during therapy was defined as a QTc interval >470 ms...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier Ltd and International Society of Antimicrobial Chemotherapy.
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7444635/ https://www.ncbi.nlm.nih.gov/pubmed/32853675 http://dx.doi.org/10.1016/j.ijantimicag.2020.106142 |
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author | Padilla, Sergio Telenti, Guillermo Guillén, Lucía García, José A. García-Abellán, Javier Ding, Carolina Mora, Antonia García-Pachón, Eduardo Gutiérrez, Félix Masiá, Mar |
author_facet | Padilla, Sergio Telenti, Guillermo Guillén, Lucía García, José A. García-Abellán, Javier Ding, Carolina Mora, Antonia García-Pachón, Eduardo Gutiérrez, Félix Masiá, Mar |
author_sort | Padilla, Sergio |
collection | PubMed |
description | This longitudinal, prospective cohort study aimed to assess risk of QTc interval prolongation and its predicting factors in subjects treated with combinations containing hydroxychloroquine (HCQ) for COVID-19. Moderate-to-severe QTc prolongation during therapy was defined as a QTc interval >470 ms in men or >480 ms in women. Patients were treated under strict cardiac supervision. A total of 105 adults were included [56% male; median (IQR) age 69 (57–79) years]. All patients received therapy with HCQ in combination with azithromycin (AZM), and 95 (90%) also with lopinavir/ritonavir (LPV/r). Concomitant medications classified as having risk of developing torsades de pointes (TdP) were simultaneously used in 81 patients (77%). Moderate-to-severe QTc prolongation was observed in 14 patients (13%), mostly at Days 3–5 from baseline, with 6 (6%) developing severe prolongation (>500 ms). There was no evidence of TdP arrhythmia or TdP-associated death. Adding LPV/r to HCQ+AZM did not significantly prolong the QTc interval. Multivariable Cox regression revealed that comedications with known risk of TdP (HR = 11.28, 95% CI 1.08–117.41), higher neutrophil-to-lymphocyte (NLR) ratio (HR = 1.10, 95% CI 1.03–1.18 per unit increase) and higher serum hs-cardiac troponin I (HR = 4.09, 95% CI 1.36–12.2 per unit increase) were major contributors to moderate-to-severe QTc prolongation. In this closely screened and monitored cohort, no complications derived from QTc prolongation were observed during pharmacological therapy containing HCQ for COVID-19. Evidence of myocardial injury with elevated troponin and strong inflammatory response, specifically higher NLR, are conditions requiring careful QTc interval monitoring. |
format | Online Article Text |
id | pubmed-7444635 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Elsevier Ltd and International Society of Antimicrobial Chemotherapy. |
record_format | MEDLINE/PubMed |
spelling | pubmed-74446352020-08-26 Predictive factors for cardiac conduction abnormalities with hydroxychloroquine-containing combinations for COVID-19 Padilla, Sergio Telenti, Guillermo Guillén, Lucía García, José A. García-Abellán, Javier Ding, Carolina Mora, Antonia García-Pachón, Eduardo Gutiérrez, Félix Masiá, Mar Int J Antimicrob Agents Article This longitudinal, prospective cohort study aimed to assess risk of QTc interval prolongation and its predicting factors in subjects treated with combinations containing hydroxychloroquine (HCQ) for COVID-19. Moderate-to-severe QTc prolongation during therapy was defined as a QTc interval >470 ms in men or >480 ms in women. Patients were treated under strict cardiac supervision. A total of 105 adults were included [56% male; median (IQR) age 69 (57–79) years]. All patients received therapy with HCQ in combination with azithromycin (AZM), and 95 (90%) also with lopinavir/ritonavir (LPV/r). Concomitant medications classified as having risk of developing torsades de pointes (TdP) were simultaneously used in 81 patients (77%). Moderate-to-severe QTc prolongation was observed in 14 patients (13%), mostly at Days 3–5 from baseline, with 6 (6%) developing severe prolongation (>500 ms). There was no evidence of TdP arrhythmia or TdP-associated death. Adding LPV/r to HCQ+AZM did not significantly prolong the QTc interval. Multivariable Cox regression revealed that comedications with known risk of TdP (HR = 11.28, 95% CI 1.08–117.41), higher neutrophil-to-lymphocyte (NLR) ratio (HR = 1.10, 95% CI 1.03–1.18 per unit increase) and higher serum hs-cardiac troponin I (HR = 4.09, 95% CI 1.36–12.2 per unit increase) were major contributors to moderate-to-severe QTc prolongation. In this closely screened and monitored cohort, no complications derived from QTc prolongation were observed during pharmacological therapy containing HCQ for COVID-19. Evidence of myocardial injury with elevated troponin and strong inflammatory response, specifically higher NLR, are conditions requiring careful QTc interval monitoring. Elsevier Ltd and International Society of Antimicrobial Chemotherapy. 2020-10 2020-08-24 /pmc/articles/PMC7444635/ /pubmed/32853675 http://dx.doi.org/10.1016/j.ijantimicag.2020.106142 Text en © 2020 Elsevier Ltd and International Society of Antimicrobial Chemotherapy. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. |
spellingShingle | Article Padilla, Sergio Telenti, Guillermo Guillén, Lucía García, José A. García-Abellán, Javier Ding, Carolina Mora, Antonia García-Pachón, Eduardo Gutiérrez, Félix Masiá, Mar Predictive factors for cardiac conduction abnormalities with hydroxychloroquine-containing combinations for COVID-19 |
title | Predictive factors for cardiac conduction abnormalities with hydroxychloroquine-containing combinations for COVID-19 |
title_full | Predictive factors for cardiac conduction abnormalities with hydroxychloroquine-containing combinations for COVID-19 |
title_fullStr | Predictive factors for cardiac conduction abnormalities with hydroxychloroquine-containing combinations for COVID-19 |
title_full_unstemmed | Predictive factors for cardiac conduction abnormalities with hydroxychloroquine-containing combinations for COVID-19 |
title_short | Predictive factors for cardiac conduction abnormalities with hydroxychloroquine-containing combinations for COVID-19 |
title_sort | predictive factors for cardiac conduction abnormalities with hydroxychloroquine-containing combinations for covid-19 |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7444635/ https://www.ncbi.nlm.nih.gov/pubmed/32853675 http://dx.doi.org/10.1016/j.ijantimicag.2020.106142 |
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