ABSTRACT
OBJECTIVE: The impact of COVID-19 infection still continues all over the world and is an important cause of mortality. The mortality rate due to infection varies between 1-5%. The mortality rate is higher in those with cardiovascular risk factors, especially in cases with hypertension. Some studies have shown that blood urea nitrogen (BUN) and albumin levels are associated with worse prognosis in patients with COVID-19. In our study, we aimed to investigate whether the BUN/albumin (BAR) ratio has an effect on in-hospital mortality in hypertensive COVID-19 patients. PATIENTS AND METHODS: A total of 800 hypertensive COVID-19 patients, (618 of whom were alive and 182 died) were included in our study. Patients with a history of heart failure, malignancy, acute coronary syndrome, and myocarditis were excluded. RESULTS: The median age of the study population was 69 (60-77 IQR) years, and 305 (38%) of these patients were men. There was no statistically significant difference between the patients who died during follow-up and cases that remained alive in terms of comorbidities except chronic obstructive pulmonary disease (COPD) which was significantly lower in surviving group (p=0.014). Multivariable logistic regression analysis revealed that age [OR: 1.04, CI (1.01-1.06); p=0.002], male gender [OR: 1.85, CI (1.13-3.02); p=0.010], lymphocyte count [OR: 0.63, CI (0.40-0.98); p=0.038], SaO2 [OR: 0.82, CI (0.79-0.85); p<0.001] and BAR level [OR: 1.09, CI (1.04-1.16); p=0.001] were independent predictors of in-hospital mortality. ROC analysis yielded that BAR is a better predictor of in-hospital mortality compared to albumin and BUN alone. CONCLUSIONS: BUN, albumin, and BAR levels were found to be reliable predictors of in-hospital mortality in COVID-19 patients, and BAR was also found to be a more reliable predictor than BUN and albumin levels. Hypertension is one of the major risk factors for morbidity and mortality in COVID-19 and, BAR presents additional prognostic data in hypertensive COVID-19 patients that may direct physicians for treatment intensification.
Subject(s)
COVID-19 , Hypertension , Humans , Male , Female , Blood Urea Nitrogen , Hospital Mortality , Biomarkers , Prognosis , Albumins , Retrospective StudiesABSTRACT
Background and Aim: Malignant ventricular arrhythmia is an important cause of mortality in COVID-19 patients (1-3). In our study, we aimed to investigate the cardiac electrophysiological balance index (ICEB), which predicts the risk of malignant ventricular arrhythmia in patients with COVID-19 who developed SIRS (systemic inflammatory response syndrome). Method(s): After exclusion criteria (atrial fibrillation, left bundle branch block, pre-excitation), a total of 533 COVID-19 patients, of whom 197 (37%) were SIRS, were included in the study. Result(s): The average age in the study population was 62 (49-72), and the gender distribution was 49% (261) female, 51% (272) male. The patients were divided into two groups as the control group with SIRS and the control group without SIRS. The clinical, laboratory and demographic characteristics of the patients were compared in Table 1. The QTc/QRS ratio (ICEBc) in the SIRS group was 5.1 (4.64-5.1) and was significantly higher than 4.98 (4.5-5.45) in the control group (p=0.004). The QTc interval was 450 (422-474) and 427 (407-447) significantly longer in the SIRS group than the control group (p=0.001). As a result of multivariable linear regression analysis, a significant correlation was found between ICEBc and SIRS, age, gender and CRP. Conclusion(s): Malign ventricular arrhythmias developing in COVID-19 patients are an important cause of mortality. ICEBc and QTc were significantly higher in the SIRS group than in the control group. It was thought that ICEBc could be used to predict malignant ventricular arrhythmias in the patient group developing SIRS.
ABSTRACT
Hypocalcemia prolongs the QTc interval. Total calcium (TCa) measurement can be misleading in cases where the concentration of albumin is abnormal. We aimed to investigate which calcium level —ionized calcium (iCa) or TCa—may be more closely related to the QTc interval in COVID-19 patients in whom hypocalcemia and hypoalbuminemia are observed frequently. Adult patients hospitalized for COVID-19 were included in this study. ICa levels were obtained from the venous blood gas sample examined during the emergency department admission, and the TCa levels were obtained from the biochemistry results on admission. The pH-adjusted iCa (Corrected-iCa) and albumin-adjusted TCa (corrected-TCa) were calculated. The QT interval was measured from the admission ECG and corrected for heart rate using the Bazett formula. Hundred and thirty-two patients were included in the study. The mean age was 50±19 years, and 62 (47%) patients were female. Median iCa level was 1,13 mmol/L (1,08-1,18 interquartile range (IQR)), median TCa level was 2.13 mmol/L (2.02-2.22 IQR). 76 patients (57%) had hypocalcemia (iCa<1,16 mmol/L). The median QTc interva l was 431 ms (414-450 IQR). In the multivariable linear regression analysis, a significant relationship was observed between the QTc interval and iCa and corrected-iCa levels (β=-2.22, standard error (SE) =27.839, p=0.028, β=-2.16, SE=29.407, p=0.033), but no significant relationship was observed between TCa and corrected-TCa levels (β=-1.02, SE=3.959, p=0.312, β=-0.44, SE=4.635, p=0,650). A significant relationship was observed between iCa levels and the QTc interval, which was longer in patients with hypocalcemia, but there was no significant relationship observed with TCa levels.
ABSTRACT
Background and Aim: Experimental Hydroxychloroquine (HCQ)/Azithromycin (AZT) combination treatment is a widely accepted experimental treatment for COVID-19 and concerns stated about the potential lethal ventricular arrhythmias (VA). Corrected QT, Tpeak-Tend interval (Tp-e) and QT dispersion have been accepted as novel markers for the assessment of myocardial repolarization and VA. We aimed to evaluate the effects of HCQ±AZT treatment on ECG repolarization parameters among patients treated for COVID-19 and their association with the with poor prognos. Methods: All consecutive adult patients diagnosed with COVID-19 and hospitalized for treatment with HKK± AZT in participating centers were evaluated. Exclusion criteria: structural heart disease, Class I/III antiarrhythmic use, complete-bundle-branch-block, high-grade-AV-block, non-sinus rhythms and acute coronary syndrome in follow-up. Bazett qtc corrected tpte "Poor clinical outcome (PCO)" is defined as a combined definition for any of the following clinical features as in hospital death/>7 days of hospitalization/endotracheal entubation and/or ICU stay. Results: Of 312 cases, 296 patients (153 females, 56±21 years) were included for analysis. 136 patients also received AZT in addition to HCQ (46% of population, male%:female% 48.5:44 p=0.44). Mean follow up time was 8±5 days (Min-Max 1-35 days). In hospital death was observed in 14 patients (4.7%, 78±17 years) and all were due to multi-organ failure in intensive care unit. PCO occurred in 88 patients (29.7%, mean±SD 64±20 years which was significantly older, p<0.001). Female mortality rate=5.2% while male=4.2% non significant trend for females p=0.7. No lethal VA or any dysrhythmic death was observed in the follow up. QT/QTc intervals and QTdisp were significantly prolonged at the end of the treatment protocol with HCQ±AZT (mean±SD ms change from baseline to the end of the protocol in both sexes = QTc 422±30 to 431±32, p<0.001, QT dispersion-C median ± SEM ms 26±1.4 to 27±1.5 p=). 7.4% (17 cases) >50 ms Delta QTc and. TpTe, TpTe-c, QTd, QTdc and TpTe/QT parameters did not significantly prolong throughout the protocol. However, delta QTc was found to be correlated with and delta QTc >50 ms significantly predicts PCO [(OR 3.8 (95% CI 1.2-12) (p=0.02)]. Presence of prolonged long QT features on ECG at the end of the protocol (p=0.04) and QTdc >50 ms (p=0.04) were significantly associated with PCO. Conclusions: HCQ/AZT treatment prolongs QTc interval while seemingly exerting no profound effects on surface ECG repolarization parameters. This might be hypothesized as one of the reasons of observed low dysrhythmic events in our cohort of COVID-19 patients. More homogenous transmural repolarization prolongation without evident dispersion of repolarization on human myocardium obsrerved in our cohort with the HCQ use might be protective against the expected deleterious effects of ordinary QT prolonging drugs.