QTc prolongation among hydroxychloroquine sulphate-treated COVID-19 patients: An observational study.
Identifieur interne : 000235 ( Main/Exploration ); précédent : 000234; suivant : 000236QTc prolongation among hydroxychloroquine sulphate-treated COVID-19 patients: An observational study.
Auteurs : Bashar Fteiha [Israël] ; Hani Karameh [Israël] ; Ramzi Kurd [Israël] ; Batsheva Ziff-Werman [Israël] ; Itamar Feldman [Israël] ; Alon Bnaya [Israël] ; Sharon Einav [Israël] ; Amir Orlev [Israël] ; Eli Ben-Chetrit [Israël]Source :
- International journal of clinical practice [ 1742-1241 ] ; 2021.
Descripteurs français
- KwdFr :
- MESH :
- effets indésirables : Hydroxychloroquine.
- induit chimiquement : Syndrome du QT long.
- traitement médicamenteux : Syndrome du QT long.
- Association de médicaments, Azithromycine, Femelle, Humains, Mâle, Sujet âgé, Électrocardiographie.
English descriptors
- KwdEn :
- MESH :
- chemical , adverse effects : Hydroxychloroquine.
- chemical : Azithromycin.
- chemically induced : Long QT Syndrome.
- drug therapy : COVID-19, Long QT Syndrome.
- Aged, Drug Therapy, Combination, Electrocardiography, Female, Humans, Male, SARS-CoV-2.
Abstract
BACKGROUND
The liberal administration of hydroxychloroquine-sulphate (HCQ) to COVID-19 patients has raised concern regarding the risk of QTc prolongation and cardiac arrhythmias, particularly when prescribed with azithromycin. We evaluated the incidence of QTc prolongation among moderately and severely ill COVID-19 patients treated with HCQ and of the existence of concomitant alternative causes.
METHODS
All COVID-19 patients treated with HCQ (between Mar 1 and Apr 14, 2020) in a tertiary medical centre were included. Clinical characteristics and relevant risk factors were collected from the electronic medical records. Individual patient QTc intervals were determined before and after treatment with HCQ. The primary outcome measure sought was a composite end point comprised of either an increase ≥60 milliseconds (ms) in the QTc interval compared with pre-treatment QTc, and/or a maximal QTc interval >500 ms RESULTS: Ninety patients were included. Median age was 65 years (IQR 55-75) and 57 (63%) were male. Thirty-nine patients (43%) were severely or critically ill. Hypertension and obesity were common (n = 23 each, 26%). QTc prolongation evolved in 14 patients (16%). Age >65 years, congestive heart failure, severity of disease, C-reactive protein level, hypokalaemia and furosemide treatment, were all associated with QTc prolongation. Adjusted analysis showed that QTc prolongation was five times more likely with hypokalaemia [OR 5, (95% CI, 1.3-20)], and three times more likely with furosemide treatment [OR 3 (95% CI, 1.01-13.7)].
CONCLUSION
In patients treated with HCQ, QTc prolongation was associated with the presence of traditional risk factors such as hypokalaemia and furosemide treatment.
DOI: 10.1111/ijcp.13767
PubMed: 33063447
PubMed Central: PMC7646017
Affiliations:
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Jerusalem, Israel.</nlm:affiliation><country xml:lang="fr">Israël</country><wicri:regionArea>Internal Medicine Department, Shaare Zedek Medical Center, School of Medicine, Hebrew University, Jerusalem</wicri:regionArea><wicri:noRegion>Jerusalem</wicri:noRegion></affiliation></author><author><name sortKey="Bnaya, Alon" sort="Bnaya, Alon" uniqKey="Bnaya A" first="Alon" last="Bnaya">Alon Bnaya</name><affiliation wicri:level="1"><nlm:affiliation>The Adult Nephrology institute, Shaare Zedek Medical Center, School of Medicine, Hebrew University, Jerusalem, Israel.</nlm:affiliation><country xml:lang="fr">Israël</country><wicri:regionArea>The Adult Nephrology institute, Shaare Zedek Medical Center, School of Medicine, Hebrew University, Jerusalem</wicri:regionArea><wicri:noRegion>Jerusalem</wicri:noRegion></affiliation></author><author><name sortKey="Einav, Sharon" sort="Einav, Sharon" uniqKey="Einav S" first="Sharon" last="Einav">Sharon Einav</name><affiliation wicri:level="1"><nlm:affiliation>Faculty of Medicine, Hebrew University, Jerusalem, Israel.</nlm:affiliation><country xml:lang="fr">Israël</country><wicri:regionArea>Faculty of Medicine, Hebrew University, Jerusalem</wicri:regionArea><wicri:noRegion>Jerusalem</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:affiliation>Intensive Care Unit, Shaare Zedek Medical Center, School of Medicine, Hebrew University, Jerusalem, Israel.</nlm:affiliation><country xml:lang="fr">Israël</country><wicri:regionArea>Intensive Care Unit, Shaare Zedek Medical Center, School of Medicine, Hebrew University, Jerusalem</wicri:regionArea><wicri:noRegion>Jerusalem</wicri:noRegion></affiliation></author><author><name sortKey="Orlev, Amir" sort="Orlev, Amir" uniqKey="Orlev A" first="Amir" last="Orlev">Amir Orlev</name><affiliation wicri:level="1"><nlm:affiliation>Faculty of Medicine, Hebrew University, Jerusalem, Israel.</nlm:affiliation><country 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Jerusalem</wicri:regionArea><wicri:noRegion>Jerusalem</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:affiliation>Infectious Diseases Unit, Shaare Zedek Medical Center, School of Medicine, Hebrew University, Jerusalem, Israel.</nlm:affiliation><country xml:lang="fr">Israël</country><wicri:regionArea>Infectious Diseases Unit, Shaare Zedek Medical Center, School of Medicine, Hebrew University, Jerusalem</wicri:regionArea><wicri:noRegion>Jerusalem</wicri:noRegion></affiliation></author></analytic><series><title level="j">International journal of clinical practice</title><idno type="eISSN">1742-1241</idno><imprint><date when="2021" type="published">2021</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged (MeSH)</term><term>Azithromycin (MeSH)</term><term>COVID-19 (drug therapy)</term><term>Drug Therapy, Combination (MeSH)</term><term>Electrocardiography (MeSH)</term><term>Female (MeSH)</term><term>Humans (MeSH)</term><term>Hydroxychloroquine (adverse effects)</term><term>Long QT Syndrome (chemically induced)</term><term>Long QT Syndrome (drug therapy)</term><term>Male (MeSH)</term><term>SARS-CoV-2 (MeSH)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Association de médicaments (MeSH)</term><term>Azithromycine (MeSH)</term><term>Femelle (MeSH)</term><term>Humains (MeSH)</term><term>Hydroxychloroquine (effets indésirables)</term><term>Mâle (MeSH)</term><term>Sujet âgé (MeSH)</term><term>Syndrome du QT long (induit chimiquement)</term><term>Syndrome du QT long (traitement médicamenteux)</term><term>Électrocardiographie (MeSH)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Hydroxychloroquine</term></keywords><keywords scheme="MESH" type="chemical" xml:lang="en"><term>Azithromycin</term></keywords><keywords scheme="MESH" qualifier="chemically induced" xml:lang="en"><term>Long QT Syndrome</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>COVID-19</term><term>Long QT Syndrome</term></keywords><keywords scheme="MESH" qualifier="effets indésirables" xml:lang="fr"><term>Hydroxychloroquine</term></keywords><keywords scheme="MESH" qualifier="induit chimiquement" xml:lang="fr"><term>Syndrome du QT long</term></keywords><keywords scheme="MESH" qualifier="traitement médicamenteux" xml:lang="fr"><term>Syndrome du QT long</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Drug Therapy, Combination</term><term>Electrocardiography</term><term>Female</term><term>Humans</term><term>Male</term><term>SARS-CoV-2</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Association de médicaments</term><term>Azithromycine</term><term>Femelle</term><term>Humains</term><term>Mâle</term><term>Sujet âgé</term><term>Électrocardiographie</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>The liberal administration of hydroxychloroquine-sulphate (HCQ) to COVID-19 patients has raised concern regarding the risk of QTc prolongation and cardiac arrhythmias, particularly when prescribed with azithromycin. We evaluated the incidence of QTc prolongation among moderately and severely ill COVID-19 patients treated with HCQ and of the existence of concomitant alternative causes.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>All COVID-19 patients treated with HCQ (between Mar 1 and Apr 14, 2020) in a tertiary medical centre were included. Clinical characteristics and relevant risk factors were collected from the electronic medical records. Individual patient QTc intervals were determined before and after treatment with HCQ. The primary outcome measure sought was a composite end point comprised of either an increase ≥60 milliseconds (ms) in the QTc interval compared with pre-treatment QTc, and/or a maximal QTc interval >500 ms RESULTS: Ninety patients were included. Median age was 65 years (IQR 55-75) and 57 (63%) were male. Thirty-nine patients (43%) were severely or critically ill. Hypertension and obesity were common (n = 23 each, 26%). QTc prolongation evolved in 14 patients (16%). Age >65 years, congestive heart failure, severity of disease, C-reactive protein level, hypokalaemia and furosemide treatment, were all associated with QTc prolongation. Adjusted analysis showed that QTc prolongation was five times more likely with hypokalaemia [OR 5, (95% CI, 1.3-20)], and three times more likely with furosemide treatment [OR 3 (95% CI, 1.01-13.7)].</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSION</b></p><p>In patients treated with HCQ, QTc prolongation was associated with the presence of traditional risk factors such as hypokalaemia and furosemide treatment.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" IndexingMethod="Automated" Owner="NLM"><PMID Version="1">33063447</PMID><DateCompleted><Year>2021</Year><Month>05</Month><Day>11</Day></DateCompleted><DateRevised><Year>2021</Year><Month>05</Month><Day>11</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1742-1241</ISSN><JournalIssue CitedMedium="Internet"><Volume>75</Volume><Issue>3</Issue><PubDate><Year>2021</Year><Month>Mar</Month></PubDate></JournalIssue><Title>International journal of clinical practice</Title><ISOAbbreviation>Int J Clin Pract</ISOAbbreviation></Journal><ArticleTitle>QTc prolongation among hydroxychloroquine sulphate-treated COVID-19 patients: An observational study.</ArticleTitle><Pagination><MedlinePgn>e13767</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1111/ijcp.13767</ELocationID><Abstract><AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">The liberal administration of hydroxychloroquine-sulphate (HCQ) to COVID-19 patients has raised concern regarding the risk of QTc prolongation and cardiac arrhythmias, particularly when prescribed with azithromycin. We evaluated the incidence of QTc prolongation among moderately and severely ill COVID-19 patients treated with HCQ and of the existence of concomitant alternative causes.</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">All COVID-19 patients treated with HCQ (between Mar 1 and Apr 14, 2020) in a tertiary medical centre were included. Clinical characteristics and relevant risk factors were collected from the electronic medical records. Individual patient QTc intervals were determined before and after treatment with HCQ. The primary outcome measure sought was a composite end point comprised of either an increase ≥60 milliseconds (ms) in the QTc interval compared with pre-treatment QTc, and/or a maximal QTc interval >500 ms RESULTS: Ninety patients were included. Median age was 65 years (IQR 55-75) and 57 (63%) were male. Thirty-nine patients (43%) were severely or critically ill. Hypertension and obesity were common (n = 23 each, 26%). QTc prolongation evolved in 14 patients (16%). Age >65 years, congestive heart failure, severity of disease, C-reactive protein level, hypokalaemia and furosemide treatment, were all associated with QTc prolongation. Adjusted analysis showed that QTc prolongation was five times more likely with hypokalaemia [OR 5, (95% CI, 1.3-20)], and three times more likely with furosemide treatment [OR 3 (95% CI, 1.01-13.7)].</AbstractText><AbstractText Label="CONCLUSION" NlmCategory="CONCLUSIONS">In patients treated with HCQ, QTc prolongation was associated with the presence of traditional risk factors such as hypokalaemia and furosemide treatment.</AbstractText><CopyrightInformation>© 2020 John Wiley & Sons Ltd.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Fteiha</LastName><ForeName>Bashar</ForeName><Initials>B</Initials><Identifier Source="ORCID">https://orcid.org/0000-0001-7676-9447</Identifier><AffiliationInfo><Affiliation>Internal Medicine Department, Shaare Zedek Medical Center, School of Medicine, Hebrew University, Jerusalem, Israel.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Faculty of Medicine, Hebrew University, Jerusalem, Israel.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Karameh</LastName><ForeName>Hani</ForeName><Initials>H</Initials><AffiliationInfo><Affiliation>Internal Medicine Department, Shaare Zedek Medical Center, School of Medicine, Hebrew University, Jerusalem, Israel.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Jesselson Integrated Heart Center, Shaare Zedek Medical Center, School of Medicine, Hebrew University, Jerusalem, Israel.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kurd</LastName><ForeName>Ramzi</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Internal Medicine Department, Shaare Zedek Medical Center, School of Medicine, Hebrew University, Jerusalem, Israel.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ziff-Werman</LastName><ForeName>Batsheva</ForeName><Initials>B</Initials><AffiliationInfo><Affiliation>Internal Medicine Department, Shaare Zedek Medical Center, School of Medicine, Hebrew University, Jerusalem, Israel.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Feldman</LastName><ForeName>Itamar</ForeName><Initials>I</Initials><AffiliationInfo><Affiliation>Internal Medicine Department, Shaare Zedek Medical Center, School of Medicine, Hebrew University, Jerusalem, Israel.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Bnaya</LastName><ForeName>Alon</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>The Adult Nephrology institute, Shaare Zedek Medical Center, School of Medicine, Hebrew University, Jerusalem, Israel.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Einav</LastName><ForeName>Sharon</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Faculty of Medicine, Hebrew University, Jerusalem, Israel.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Intensive Care Unit, Shaare Zedek Medical Center, School of Medicine, Hebrew University, Jerusalem, Israel.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Orlev</LastName><ForeName>Amir</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Faculty of Medicine, Hebrew University, Jerusalem, Israel.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Jesselson Integrated Heart Center, Shaare Zedek Medical Center, School of Medicine, Hebrew University, Jerusalem, Israel.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ben-Chetrit</LastName><ForeName>Eli</ForeName><Initials>E</Initials><AffiliationInfo><Affiliation>Faculty of Medicine, Hebrew University, Jerusalem, Israel.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Infectious Diseases Unit, Shaare Zedek Medical Center, School of Medicine, Hebrew University, Jerusalem, Israel.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D064888">Observational Study</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>12</Month><Day>18</Day></ArticleDate></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>Int J Clin Pract</MedlineTA><NlmUniqueID>9712381</NlmUniqueID><ISSNLinking>1368-5031</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>4QWG6N8QKH</RegistryNumber><NameOfSubstance UI="D006886">Hydroxychloroquine</NameOfSubstance></Chemical><Chemical><RegistryNumber>83905-01-5</RegistryNumber><NameOfSubstance UI="D017963">Azithromycin</NameOfSubstance></Chemical></ChemicalList><SupplMeshList><SupplMeshName Type="Protocol" UI="C000705127">COVID-19 drug treatment</SupplMeshName></SupplMeshList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D017963" MajorTopicYN="N">Azithromycin</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000086382" MajorTopicYN="Y">COVID-19</DescriptorName><QualifierName UI="Q000188" MajorTopicYN="N">drug therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D004359" MajorTopicYN="N">Drug Therapy, Combination</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004562" MajorTopicYN="N">Electrocardiography</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006886" MajorTopicYN="N">Hydroxychloroquine</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008133" MajorTopicYN="Y">Long QT Syndrome</DescriptorName><QualifierName UI="Q000139" MajorTopicYN="N">chemically induced</QualifierName><QualifierName UI="Q000188" MajorTopicYN="N">drug therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000086402" MajorTopicYN="N">SARS-CoV-2</DescriptorName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="revised"><Year>2020</Year><Month>09</Month><Day>08</Day></PubMedPubDate><PubMedPubDate PubStatus="received"><Year>2020</Year><Month>06</Month><Day>16</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2020</Year><Month>10</Month><Day>04</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2020</Year><Month>10</Month><Day>17</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2021</Year><Month>5</Month><Day>12</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2020</Year><Month>10</Month><Day>16</Day><Hour>6</Hour><Minute>2</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">33063447</ArticleId><ArticleId IdType="doi">10.1111/ijcp.13767</ArticleId><ArticleId IdType="pmc">PMC7646017</ArticleId></ArticleIdList><ReferenceList><Title>REFERENCES</Title><Reference><Citation>Yao X, Ye F, Zhang M, et al. 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JAMA. 2020;323:2493-2502.</Citation></Reference></ReferenceList></PubmedData></pubmed><affiliations><list><country><li>Israël</li></country></list><tree><country name="Israël"><noRegion><name sortKey="Fteiha, Bashar" sort="Fteiha, Bashar" uniqKey="Fteiha B" first="Bashar" last="Fteiha">Bashar Fteiha</name></noRegion><name sortKey="Ben Chetrit, Eli" sort="Ben Chetrit, Eli" uniqKey="Ben Chetrit E" first="Eli" last="Ben-Chetrit">Eli Ben-Chetrit</name><name sortKey="Ben Chetrit, Eli" sort="Ben Chetrit, Eli" uniqKey="Ben Chetrit E" first="Eli" last="Ben-Chetrit">Eli Ben-Chetrit</name><name sortKey="Bnaya, Alon" sort="Bnaya, Alon" uniqKey="Bnaya A" first="Alon" last="Bnaya">Alon Bnaya</name><name sortKey="Einav, Sharon" sort="Einav, Sharon" uniqKey="Einav S" first="Sharon" last="Einav">Sharon Einav</name><name sortKey="Einav, Sharon" sort="Einav, Sharon" uniqKey="Einav S" first="Sharon" last="Einav">Sharon Einav</name><name sortKey="Feldman, Itamar" sort="Feldman, Itamar" uniqKey="Feldman I" first="Itamar" last="Feldman">Itamar Feldman</name><name sortKey="Fteiha, Bashar" sort="Fteiha, Bashar" uniqKey="Fteiha B" first="Bashar" last="Fteiha">Bashar Fteiha</name><name sortKey="Karameh, Hani" sort="Karameh, Hani" uniqKey="Karameh H" first="Hani" last="Karameh">Hani Karameh</name><name sortKey="Karameh, Hani" sort="Karameh, Hani" uniqKey="Karameh H" first="Hani" last="Karameh">Hani Karameh</name><name sortKey="Kurd, Ramzi" sort="Kurd, Ramzi" uniqKey="Kurd R" first="Ramzi" last="Kurd">Ramzi Kurd</name><name sortKey="Orlev, Amir" sort="Orlev, Amir" uniqKey="Orlev A" first="Amir" last="Orlev">Amir Orlev</name><name sortKey="Orlev, Amir" sort="Orlev, Amir" uniqKey="Orlev A" first="Amir" last="Orlev">Amir Orlev</name><name sortKey="Ziff Werman, Batsheva" sort="Ziff Werman, Batsheva" uniqKey="Ziff Werman B" first="Batsheva" last="Ziff-Werman">Batsheva Ziff-Werman</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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