ABSTRACT
Background Objective: What is the association between COVID-19 infection and QTc changes? Coronavirus SARS-COV2 uses angiotensin-converting enzyme receptors 2 (ACE2) on host cells to enter into human cells. These receptors are expressed on the heart cells among other major cells. This is one of the most accepted theories for direct cardiac cell injury of COVID-19disease and associated cardiorespiratory manifestations. COVID-19 infection leads to unstable myocardial cell membranes, by causing hypoxia, myocarditis, myocardial ischemia, and abnormal host immune response. This is the main reason behind Arrhythmia and EKG changes during COVID19 infection. But the specific effect on QTc has not been studied well so far, so our research try to study this connection. Method(s): This is an observational retrospective hospital chart review involving 320 adult participants diagnosed with COVID-19 infection at our facility. After applying the exclusion criteria, 130 participants remained, who were distributed into two groups. One group with long QTc and one group with normal QTc. Data was collected and demographics were recorded using Excel and SPSS, then compared using a student's t-test for independent groups. The quantitative data are summarized by the mean and standard deviation (SD). Statistical significance was taken as P <0.05. Result(s): A total of 63 participants (48.4% of total 130 participants) met the criteria for long QTc, and a total of 67 participants(51.5%) had normal QTc (P < 0.001). There was no statistically significant mortality outcome (0.8% vs. 3.8%, P = 0.21). Conclusion(s): Our study showed 48.4% participants having an increase in QTc during COVID-19 infection, (20% of 320 total admissions). This observation is very important to help healthcare providers to gaina better understanding of this disease.
ABSTRACT
INTRODUCTION: In this systematic review, we assessed the clinical outcomes, benefits, and adverse effects associated with tocilizumab use in hospitalized COVID-19 patients. We aimed to seek insight on the role of tocilizumab in COVID-19 associated hospitalization. METHODS: A literature search was conducted using the electronic database engines WHO, PubMed, and Google Scholar from December 1st 2019 to June 22nd 2020. The inclusion criteria of the primary studies for our review included: 1) RT-PCR SARS-CoV-2 positive patients/ Confirmed COVID-19 patients, 2) Age>/= 18, 3) Need for hospitalization-, 4) Use of tocilizumab for the treatment of COVID-19. The search strategy retrieved 383 studies in total, of which only 37 qualified for inclusion with a total of 677 patients. The primary outcomes analyzed in this study were patients' ?clinical improvement/recovery or stabilization?, ?clinical deterioration but alive at the end of the study? after tocilizumab administration and mortality rate. The secondary outcomes included length of hospital stay (LOS), radiological improvement, and mean change in C - reactive protein (CRP) levels before and after tocilizumab administration, mean change in ferritin levels before and after tocilizumab administration and adverse events. RESULTS: After the administration of 1 or more doses of tocilizumab, clinical improvement/recovery or stabilization was noted in 462 (68.2%) out of 677 patients, whereas 31 (4.6 %) out of 677 patients clinically deteriorated but remained alive at the end of the study. A total of 103 (15.2%) patients died. Radiological improvement was noted in 108 (69.7%) out of 155 patients, the average LOS reported ranged from 5 to 25 days, mean change in CRP levels before and after tocilizumab administration reported ranged from 5.9 mg/L to 2400 mg/L, and the mean decrease in ferritin levels before and after tocilizumab administration reported ranged from 62.08 ng/ml to 51156 ng/ml. Finally, 97 (14.3 %) out of 677 patients experienced one or more adverse events. CONCLUSIONS: In a literature review of 37 studies, Tocilizumab as a management of critically ill hospitalized patients with COVID-19, this drug was found to be associated with improvement in both survival and radiological findings. A minority of patients were reported to have adverse events.