Title:QTc Prolongation to Predict Mortality in Patients Admitted with
COVID-19 Infection: An Observational Study
Volume: 22
Issue: 2
Author(s): Andrea Sartorio, Giulia Burrei, Luca Cristin, Mirko Zoncapè, Michele Carlin, Enrico Tadiello, Pietro Minuz, Andrea Dalbeni and Simone Romano*
Affiliation:
- Division of Internal Medicine C, Department of Medicine, University of Verona, Italy
Keywords:
COVID-19, COVID-19 drugs, mortality, pneumonia, QTc prolongation, SARS-CoV-2.
Abstract:
Background: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causes
Coronavirus disease 2019 (COVID-19), characterized by pulmonary infection ranging from asymptomatic
forms to respiratory insufficiency and death. Evidence of cardiac involvement in COVID-19
is increasing, and systemic inflammation or direct heart damage by SARS-CoV-2 can prolong the
corrected QT interval (QTc).
Methods: In this observational study, a total of 333 consecutive patients admitted to the Covid Center
of Verona University Hospital from November 2020 to April 2021 were included. Patients with bundle
branch block, pacemaker-controlled heart rhythm and heart rate >120 beats/min were excluded. A
complete electrocardiogram (ECG) was performed at admission, and QTc values of ≥440 ms for
males and ≥460 ms for females were considered prolonged.
Results: Overall, 153 patients had prolonged QTc (45.5%). In multivariate logistic regression analysis,
male sex (odds ratio (OR)=6.612, p=0.046), troponin (OR=1.04, p=0.015) and lymphocyte count
(OR=3.047, p=0.019) were independently associated with QTc prolongation. Multivariate logistic
regression showed that QTc was independently associated with mortality (OR=4.598, p=0.036). Age,
sex, the ratio between the partial pressure of oxygen (PaO2) and the fraction of inspired oxygen
(FiO2) (P/F), and fibrosis-4 index for liver fibrosis (FIB-4) were also independently associated with
mortality.
Conclusion: QTc interval prolongation appears to be a frequent finding in patients with COVID-19.
Moreover, prolonged QTc may be predictive of more severe forms of COVID-19 and worse outcome.
