QTc interval is associated with increased inflammatory markers (neutrophil-to-lymphocyte ratio and LDH level) in COVID-19 patients

Year 2021, Volume: 46 Issue: 4, 1711 - 1718, 30.12.2021

Şerife Torun , Irem Karaman , Nurtaç Özer , Çaşıt Olgun Çelik , M. Şule Akçay

Abstract

Purpose: This study aimed to investigate the association between QTc interval and laboratory parameters in COVID-19 patients before and after the treatment.
Materials and Methods: Forty-three COVID-19 patients who had baseline and follow-up ECG findings and laboratory reports were evaluated and 40 patients were included in the study.
Results: Among 40 patients, 16 were women and 24 were men. The neutrophil-to-lymphocyte ratio (NLR) and corrected QT (QTc) interval were significantly higher in females than males. After the treatment, a significant fall in CRP and ferritin values, and significantly prolonged QTc interval were seen. A significant positive correlation was observed between QTc interval and age, LDH levels, neutrophil and leukocyte count, NLR, magnesium levels, and heart rate of the patients prior to treatment. A positive correlation was observed between increased QTc interval and decreased LDH levels and NLR after treatment.
Conclusion: QTc prolongation was associated with increased inflammatory markers, increased NLR and LDH levels before and after treatment in COVID-19 patients. The increase in the QTc interval was correlated with the reduction in LDH levels and NLR with treatment.

Keywords

COVID-19, electrocardiogram, QTc interval, inflammation, neutrophil-to-lymphocyte ratio, LDH

Supporting Institution

Baskent University

Project Number

E-94603339-604.01.02-4137

Thanks

None.

QTc aralığı, COVID-19 hastalarında artan inflamatuar belirteçlerle (nötrofil-lenfosit oranı ve LDH seviyesi) ilişkilidir

Abstract

Amaç: Bu çalışma, COVID-19 hastalarının tedavi öncesi ve sonrası QTc aralığı ile laboratuvar parametreleri arasındaki ilişkiyi araştırmayı amaçlamıştır.
Gereç ve Yöntem: Başlangıç ve takip EKG bulguları ve laboratuvar raporları olan 43 COVID-19 hastası değerlendirildi ve çalışmaya 40 hasta dahil edildi.
Bulgular: 40 hastanın 16'sı kadın, 24'ü erkekti. Nötrofil/lenfosit oranı (NLO) ve düzeltilmiş QT (QTc) aralığı kadınlarda erkeklere göre anlamlı olarak daha yüksekti. Tedavi sonrası CRP ve ferritin değerlerinde belirgin düşüş ve QTc intervalinde belirgin uzama görüldü. QTc aralığı ile hastaların yaşı, tedavi öncesi LDH düzeyleri, nötrofil ve lökosit sayıları, NLO, magnezyum düzeyleri ve kalp atım hızı arasında anlamlı pozitif korelasyon gözlendi. Tedavi sonrası artan QTc aralığı ile azalmış LDH seviyeleri ve NLO arasında pozitif bir korelasyon gözlendi.
Sonuç: QTc uzaması, COVID-19 hastalarında tedaviden önce ve sonra artan inflamatuar belirteçler, artan NLR ve LDH seviyeleri ile ilişkili olarak gözlemlenmiştir. QTc aralığındaki artış, tedavi ile LDH seviyelerindeki ve NLR'deki azalma ile korele idi.

Keywords

COVID-19, elektrokardiyogram, QTc aralığı, inflamasyon, nötrofil-lenfosit oranı, LDH

Project Number

E-94603339-604.01.02-4137

References

• 1. Zheng HY, Zhang M, Yang CX, Zhang N, Wang XC, Yang XP, et al. Elevated exhaustion levels and reduced functional diversity of T cells in peripheral blood may predict severe progression in COVID-19 patients. Cell Mol Immunol. 2020;17(5):541-3.
• 2. Jimeno S, Ventura PS, Castellano JM, García-Adasme SI, Miranda M, Touza P, et al. Prognostic implications of neutrophil-lymphocyte ratio in COVID-19. Eur J Clin Invest. 2021;51(1):e13404.
• 3. Jain U. Effect of COVID-19 on the Organs. Cureus. 2020;12(8):e9540.
• 4. Çap M, Bilge Ö, Işık F, Burak C, Karagöz A, İnci Ü, et al. The effect of favipiravir on QTc interval in patients hospitalized with coronavirus disease 2019. J Electrocardiol. 2020;63:115-9.
• 5. Santoro F, Monitillo F, Raimondo P, Lopizzo A, Brindicci G, Gilio M, et al. QTc interval prolongation and life-threatening arrhythmias during hospitalization in patients with COVID-19. Results from a multi-center prospective registry. Clin Infect Dis. 2020.
• 6. Sonsoz MR, Oncul A, Cevik E, Orta H, Yilmaz M, Ayduk Govdeli E, et al. Wide QRS Complex and Lateral ST-T Segment Abnormality Are Associated With Worse Clinical Outcomes in COVID-19 Patients. Am J Med Sci. 2021;361(5):591-7.
• 7. Pavri BB, Kloo J, Farzad D, Riley JM. Behavior of the PR interval with increasing heart rate in patients with COVID-19. Heart Rhythm. 2020;17(9):1434-8.
• 8. Ece İ, Koçoğlu M, Kavurt AV, Bağrul D, Gül AEK, Koca S, et al. Assessment of Cardiac Arrhythmic Risk in Children With Covid-19 Infection. Pediatr Cardiol. 2021;42(2):264-8.
• 9. Rubin GA, Desai AD, Chai Z, Wang A, Chen Q, Wang AS, et al. Cardiac Corrected QT Interval Changes Among Patients Treated for COVID-19 Infection During the Early Phase of the Pandemic. JAMA Netw Open. 2021;4(4):e216842.
• 10. Das MK, El Masry H. Fragmented QRS and other depolarization abnormalities as a predictor of mortality and sudden cardiac death. Curr Opin Cardiol. 2010;25(1):59-64.
• 11. Bernardini A, Ciconte G, Negro G, Rondine R, Mecarocci V, Viva T, et al. Assessing QT interval in COVID-19 patients:safety of hydroxychloroquine-azithromycin combination regimen. Int J Cardiol. 2021;324:242-8.
• 12. Wang L. C-reactive protein levels in the early stage of COVID-19. Med Mal Infect. 2020;50(4):332-4.
• 13. Li C, Ye J, Chen Q, Hu W, Wang L, Fan Y, et al. Elevated Lactate Dehydrogenase (LDH) level as an independent risk factor for the severity and mortality of COVID-19. Aging (Albany NY). 2020;12(15):15670-81.
• 14. Upadhyay J, Tiwari N, Ansari MN. Role of inflammatory markers in corona virus disease (COVID-19) patients: A review. Exp Biol Med (Maywood). 2020;245(15):1368-75.
• 15. Aydemir D, Ulusu NN. Correspondence: Importance of the validated serum biochemistry and hemogram parameters for rapid diagnosis and to prevent false negative results during COVID-19 pandemic. Biotechnol Appl Biochem. 2021;68(2):390-1.
• 16. Lazzerini PE, Laghi-Pasini F, Bertolozzi I, Morozzi G, Lorenzini S, Simpatico A, et al. Systemic inflammation as a novel QT-prolonging risk factor in patients with torsades de pointes. Heart. 2017;103(22):1821-9.
• 17. Martínez-Urbistondo D, Beltrán A, Beloqui O, Huerta A. The neutrophil-to-lymphocyte ratio as a marker of systemic endothelial dysfunction in asymptomatic subjects. Nefrologia. 2016;36(4):397-403.
• 18. Liu Y, Du X, Chen J, Jin Y, Peng L, Wang HHX, et al. Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. J Infect. 2020;81(1):e6-e12.
• 19. Lagunas-Rangel FA. Neutrophil-to-lymphocyte ratio and lymphocyte-to-C-reactive protein ratio in patients with severe coronavirus disease 2019 (COVID-19): A meta-analysis. J Med Virol. 2020;92(10):1733-4.
• 20. Tatum D, Taghavi S, Houghton A, Stover J, Toraih E, Duchesne J. Neutrophil-to-Lymphocyte Ratio and Outcomes in Louisiana COVID-19 Patients. Shock. 2020;54(5):652-8.
• 21. Padilla S, Telenti G, Guillén L, García JA, García-Abellán J, Ding C, et al. Predictive factors for cardiac conduction abnormalities with hydroxychloroquine-containing combinations for COVID-19. Int J Antimicrob Agents. 2020;56(4):106142.
• 22. Cai Y-Q, Zeng H-Q, Zhang X-B, Wei X-J, Hu L, Zhang Z-Y, et al. Prognostic value of neutrophil-to-lymphocyte ratio, lactate dehydrogenase, D-Dimer and CT score in patients with COVID-19. 2020.
• 23. Wu M-y, Yao L, Wang Y, Zhu X-y, Wang X-f, Tang P-j, et al. Clinical evaluation of potential usefulness of serum lactate dehydrogenase (LDH) in 2019 novel coronavirus (COVID-19) pneumonia. Respiratory Research. 2020;21(1):1-6.
• 24. Etheridge SP, Asaki SY. COVID-19 Infection and Corrected QT Interval Prolongation—Collateral Damage From Our Newest Enemy. JAMA Network Open. 2021;4(4):e217192-e.
• 25. Micke O, Vormann J, Kisters K. Magnesium deficiency and COVID-19–What are the links? Trace Elements and Electrolytes. 2020;37(3):103.