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2021, vol. 18, br. 2, str. 63-73
QTc interval i ishod lečenja bolesnika sa COVID-19
aUniverzitet u Kragujevcu, Fakultet medicinskih nauka, Katedra za internu medicinu + Klinički centar Kragujevac, Klinika za kardiologiju
bUniverzitet u Kragujevcu, Fakultet medicinskih nauka, Katedra za farmakologiju i toksikologiju + Klinički centar Kragujevac, Služba za kliničku farmakologiju
cUniverzitet u Kragujevcu, Fakultet medicinskih nauka, Katedra za internu medicinu + Klinički centar Kragujevac, Klinika za internu medicinu
dUniverzitet u Kragujevcu, Fakultet medicinskih nauka, Katedra za farmakologiju i toksikologiju
eUniverzitet u Kragujevcu, Fakultet medicinskih nauka, Patohistološka katedra
fUniverzitet u Kragujevcu, Fakultet medicinskih nauka, Katedra za anatomiju i sudsku medicinu + Ministry of Health of the Republic of Serbia, Belgrade
gUniverzitet u Kragujevcu, Fakultet medicinskih nauka, Katedra za internu medicinu + Klinički centar Kragujevac, Klinika za pulmologiju
hKlinički centar Kragujevac, Služba za kliničku farmakologiju + Univerzitet u Kragujevcu, Fakultet medicinskih nauka, Katedra za farmakologiju i toksikologiju
iKlinički centar Kragujevac, Klinika za kardiologiju + Klinički centar Kragujevac, Služba za kliničku farmakologiju
jUniverzitet u Kragujevcu, Fakultet medicinskih nauka, Katedra za mikrobiologiju i imunologiju + Public Health Institute, Kragujevac

e-adresajovanovmejl1@gmail.com
Projekat:
Farmakološka analiza efekata biološki aktivnih supstanci na izolovane glatke mišiće gastrointestinalnog i urogenitalnog trakta čoveka (MPNTR - 175007)

Ključne reči: korona virus; pandemija; pneumonija, virusna; bolnica; antimalarici; sindrom dugog QT intervala; ishod lečenja.
Sažetak
Cilj. Nakon početka pandemije COVID-19 izazvane virusom SARS-CoV-2, pao je ogroman pritisak na ceo zdravstveni sistem. Pošto za ovu bolest ne postoji adekvatan lek, pribeglo se nelicenciranoj upotrebi nekoliko lekova (azitromicin, hlorokin, hidroksihlorokin i dr.). Cilj ove studije je bio da se analizira dinamika QTc intervala i njegov odnos sa drugim faktorima koji mogu uticati na ishod kod pacijenata sa COVID-19. Metode. Studija je imala opservacioni dizajn slučaj-kontrola sa retrospektivnim prikupljanjem podataka iz medicinske dokumentacije odraslih pacijenata, sa RT-PCR potvrđenim COVID-19. Slučajevi (n=30) su bili bolesnici sa smrtnim ishodom, a kontrole (n=169) su bili preživeli. QTc interval je izračunat pri prijemu, tokom i nakon inicijalne primene lekova sa pretpostavljenom aktivnošću protiv SARS-CoV-2, uglavnom antimalarika. Primarne nezavisne varijable i varijable ishoda bile su produženje QTc intervala odnosno mortalitet od svih uzroka. Rezultati. Ispitivana populacija je uključivala 120 muškaraca (60,3%), prosečna starost pacijenata bila je 57,3+-15,8 godina (+-SD). Najčešća komorbidna oboljenja bila su hipertenzija (98 pacijenata), postojeće aritmije (32) i dijabetes melitus (29). Najčešće propisivani lekovi koji su mogli da produže QTc interval bili su azitromicin (69,8% pacijenata), hlorokin (50,3%) i hidroksihlorokin (42,7%). Ukupno 131 pacijent (65,8%) imao je povećanje QTc intervala >60 ms u odnosu na početnu liniju, od kojih je 5 imalo produženje QTc intervala >500 ms (2,5%). De novo ventrikularne tahiaritmije su registrovane kod 14 pacijenata (7%) a od njih, umrlo je 13 (92,8%). Prethodno postojeće aritmije (odnos šanse 9,30, 95% interval poverenja 2,91-29,73, p<0,001) i furosemid (8,94, 3,27-24,41, p<0,001) su nezavisno povezani sa mortalitetom ali ne i produženje QTc intervala (1,02, 0,22-4,67, p=0,974). Stopa smrtnosti iznosila je 15,1%, pošto je 30 pacijenata umrlo tokom hospitalizacije. Zaključak: Klinički značaj produženja QTc intervala izazvanog lekovima kod hospitalizovanih pacijenata sa COVID-19 treba prvenstveno razmotriti u kontekstu drugih rizika, posebno starije životne dobi, postojećih kardiovaskularnih poremećaja i velikih poremećaja elektrolita.
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O članku

jezik rada: engleski
vrsta rada: izvorni naučni članak
DOI: 10.5937/pomc18-36358
primljen: 08.02.2022.
prihvaćen: 15.03.2022.
objavljen u SCIndeksu: 02.04.2022.

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