Purpose

Systemic inflammation has been associated with corrected QT (QTc) interval prolongation. The role of inflammation on QTc prolongation in COVID-19 patients was investigated.

Methods

Patients with a laboratory-confirmed SARS-CoV-2 infection admitted to IRCCS San Raffaele Scientific Institute (Milan, Italy) between March 14, 2020, and March 30, 2020 were included. QTc-I was defined as the QTc interval by Bazett formula in the first ECG performed during the hospitalization, before any new drug treatment; QTc-II was the QTc in the ECG performed after the initiation of hydroxychloroquine drug treatment.

Results

QTc-I was long in 45 patients (45%) and normal in 55 patients (55%). Patients with long QTc-I were older and more frequently males. C-Reactive protein (CRP) and white blood cell (WBC) count at hospitalization were higher in patients with long QTc-I and long QTc-II. QTc-I was significantly correlated with CRP levels at hospitalization. After a median follow-up of 83 days, 14 patients (14%) died. There were no deaths attributed to ventricular arrhythmias. Patients with long QTc-I and long QTc-II had a shorter survival, compared with normal QTc-I and QTc-II patients, respectively. In Cox multivariate analysis, independent predictors of mortality were age (HR = 1.1, CI 95% 1.04–1.18, p = 0.002) and CRP at ECG II (HR 1.1, CI 95% 1.0–1.1, p = 0.02).

Conclusions

QTc at hospitalization is a simple risk marker of mortality risk in COVID-19 patients and reflects the myocardial inflammatory status.

中文翻译：

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COVID-19 患者的 QTc 间期延长、炎症和死亡率

目的

全身炎症与校正的 QT (QTc) 间期延长有​​关。研究了炎症对 COVID-19 患者 QTc 延长的作用。

方法

包括 2020 年 3 月 14 日至 2020 年 3 月 30 日期间在 IRCCS San Raffaele 科学研究所（意大利米兰）收治的实验室确诊 SARS-CoV-2 感染的患者。QTc-I 定义为住院期间、任何新药治疗前首次心电图用 Bazett 公式计算的 QTc 间期；QTc-II 是在开始羟氯喹药物治疗后进行的心电图中的 QTc。

结果

45 名患者 (45%) 的 QTc-I 较长，55 名患者 (55%) 正常。长 QTc-I 的患者年龄较大，男性较多。长 QTc-I 和长 QTc-II 患者住院时 C 反应蛋白 (CRP) 和白细胞 (WBC) 计数较高。QTc-I 与住院时的 CRP 水平显着相关。中位随访 83 天后，14 名患者 (14%) 死亡。没有死于室性心律失常。与正常 QTc-I 和 QTc-II 患者相比，长 QTc-I 和长 QTc-II 患者的生存期更短。在 Cox 多变量分析中，死亡率的独立预测因子是年龄 (HR = 1.1, CI 95% 1.04–1.18, p  = 0.002) 和 ECG II 时的 CRP (HR 1.1, CI 95% 1.0–1.1, p  = 0.02)。

结论

住院时的 QTc 是 COVID-19 患者死亡风险的简单风险标志物，反映了心肌炎症状态。