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Predicting QT interval prolongation in patients diagnosed with the 2019 novel coronavirus infection
Wei Zhao1, Nikhil Gandhi1, Saif Affas1
1Department of Internal Medicine, Ascension St. John Hospital, Detroit, MI, USA.
Insights
The Tisdale Score is not effective for predicting QT interval prolongation in non-critical COVID-19 patients. Continuous cardiac monitoring is advised for those with end-stage renal disease, prolonged QTc on admission, or low potassium levels.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- COVID-19 patients are at risk for QT interval prolongation, potentially leading to Torsades de Pointes and sudden cardiac death.
- Continuous cardiac monitoring is recommended for COVID-19 patients with a Tisdale Score of seven or higher, but this has not been validated.
Purpose of the Study:
- To evaluate the accuracy of the Tisdale Score in predicting QT interval prolongation in hospitalized COVID-19 patients not in intensive care.
- To identify independent predictors of QT interval prolongation in this patient population.
Main Methods:
- A retrospective study included 178 COVID-19 patients admitted to a non-ICU setting.
- Receiver operating characteristic (ROC) curve analysis was used to assess the Tisdale Score's predictive accuracy.
- Multivariable analysis identified additional risk factors for QT interval prolongation.
Main Results:
- The Tisdale Score demonstrated poor accuracy (Area Under Curve = 0.60) for predicting QT interval prolongation.
- A Tisdale Score cutoff of seven had low specificity (7.6%) despite high sensitivity (85.7%).
- Independent predictors of QT interval prolongation included end-stage renal disease (ESRD), QTc ≥450 ms on admission, and serum potassium ≤3.5 mmol/L.
Conclusions:
- The Tisdale Score is not a reliable tool for risk stratification of non-critical COVID-19 patients regarding QT interval prolongation.
- Continuous cardiac monitoring should be considered for patients with ESRD, QTc ≥450 ms on admission, or hypokalemia (serum potassium ≤3.5 mmol/L).
Introduction:
2019 novel coronavirus (COVID-19) patients frequently develop QT interval prolongation that predisposes them to Torsades de Pointes and sudden cardiac death. Continuous cardiac monitoring has been recommended for any COVID-19 patient with a Tisdale Score of seven or more. This recommendation, however, has not been validated.
Methods:
We included 178 COVID-19 patients admitted to a non-intensive care unit setting of a tertiary academic medical center. A receiver operating characteristics curve was plotted to determine the accuracy of the Tisdale Score to predict QT interval prolongation. Multivariable analysis was performed to identify additional predictors.
Results:
The area under the curve of the Tisdale Score was 0.60 (CI 95%, 0.46-0.75). Using the cutoff of seven to stratify COVID-19, patients had a sensitivity of 85.7% and a specificity of 7.6%. Risk factors independently associated with QT interval prolongation included a history of end-stage renal disease (ESRD) (OR, 6.42; CI 95%, 1.28-32.13), QTc ≥450 ms on admission (OR, 5.90; CI 95%, 1.62-21.50), and serum potassium ≤3.5 mmol/L during hospitalization (OR, 4.97; CI 95%, 1.51-16.36).
Conclusion:
The Tisdale Score is not a useful tool to stratify hospitalized non-critical COVID-19 patients based on their risks of developing QT interval prolongation. Clinicians should initiate continuous cardiac monitoring for patients who present with a history of ESRD, QTc ≥450 ms on admission or serum potassium ≤3.5 mmol/L.
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