ABSTRACT
Background Antiviral agents, such as remdesivir, have shown promising results in helping reduce the morbidity and healthcare burden of COVID-19 in hospitalized patients. However, an increasing number of studies have reported a relationship between Remdesivir and bradycardia. Therefore, this study aims to analyze the relationship between bradycardia and outcomes in patients on remdesivir. Methods We conducted a retrospective study of 2,935 consecutive COVID-19 patients admitted to seven hospitals in Southern California in the United States between January 2020 and August 2021. First, we did a backward logistic regression to analyze the relationship between remdesivir use and other independent variables. Finally, we did a backward selection Cox multivariate regression analysis on the sub-group of patients who received remdesivir to evaluate the mortality risk in bradycardic patients on remdesivir. Results The mean age of the study population was 63 years;56% were males, 44% received remdesivir, and 52% developed bradycardia. Our analysis showed that remdesivir was associated with increased odds of bradycardia (OR 1.9, p<0.001). Patients that were on remdesivir in our study were sicker patients with increased odds of having elevated CRP (OR 1.03, p<0.001), elevated WBC on admission (OR 1.06, p<0.001), and increased length of hospital stay (OR 1.02, p=0.002). However, remdesivir was associated with a decreased odds of mechanical ventilation (OR 0.53, p<0.001). In the sub-group analysis comparing bradycardia and non-bradycardia patients that received remdesivir, bradycardia was associated with decreased mortality risk (HR 0.69, p=0.002). Conclusion Our study showed that remdesivir was associated with bradycardia in COVID-19 patients. However, it decreased the odds of being on a ventilator, even in patients with increased inflammatory markers on admission. Furthermore, patients on remdesivir that developed bradycardia did not have any increased risk of death. Therefore, clinicians should not withhold remdesivir from patients at risk of developing bradycardia because bradycardia in such patients was not found to worsen the clinical outcome.Copyright © 2023 American College of Cardiology Foundation
ABSTRACT
Introduction: Myocardial injury, causing elevated troponin levels, have been associated with worse outcomes in coronavirus disease 2019 (COVID-19) disease patients. However, our anecdotal experience did not consistently reflect this pattern. Therefore, we evaluated the outcomes of COVID-19 patients with elevated troponin. Method(s): This is a retrospective study of 1,024 COVID-19 patients admitted to two hospitals in Southern California in the United States. We categorized the troponin levels as normal (<=1x upper reference limit (URL)), mildly elevated (>1 to <=3x URL), and severely elevated (>3x URL). We compared the characteristics of the three troponin groups using chi-square for categorical variables and one-way Anova for the continuous variables. Finally, backward selection Cox regression analysis was carried out using mortality as a dependent variable. Result(s): Of the COVID-19 1,024 patients included in the study, 944 (92%) had normal troponin, 45 (4.4%) had mild elevation, and 35 (3.4%) had a severe elevation in troponin levels. In the multivariate Cox regression analysis, troponin elevation in patients without ST-elevation on ECG was not independently associated with mortality (hazard ratio 0.92, 95% CI 0.64-1.3). Increased risk of death was independently associated with age as well as serum C-reactive protein and serum creatinine levels. Conclusion(s): Elevated troponins without ST-elevation on ECG on hospital admission were not independently associated with increased mortality in hospitalized COVID-19 patients. However, further research is needed to fully understand the absence of a relationship between troponin elevation and mortality in our study population. Copyright © 2022 Umeh et al.