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Prolongación del intervalo QT en pacientes geriátricos bajo tratamiento por la infección por SARS-CoV-2: estudio OCTA-COVID
QT interval prolongation in geriatric patients treated for SARS-COV-2 infection: OCTA-COVID study
Blanca Garmendia-Prieto
Autor para correspondencia
blancagarmendia@gmail.com

Autor para correspondencia.
, Pamela Carrillo-García, Javier Gómez-Pavón
Servicio de Geriatría, Hospital Central de la Cruz Roja, San José y Santa Adela, Madrid, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">En la actual pandemia de SARS-CoV-2&#44; el uso de f&#225;rmacos como la hidroxicloroquina &#40;HQ&#41;&#44; azitromicina &#40;AZ&#41;&#44; lopinavir&#47;ritonavir &#40;LR&#41; y combinaciones de estos han demostrado tener un mayor riesgo de prolongaci&#243;n del intervalo QT<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a>&#44; debiendo tener mayor precauci&#243;n en pacientes mayores con polifarmacia y en especial&#44; con uso de psicof&#225;rmacos<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">El s&#237;ndrome de QT largo adquirido &#40;SQTLA&#41; es una alteraci&#243;n de la repolarizaci&#243;n ventricular caracterizada por un intervalo QT prolongado corregido por la frecuencia cardiaca en el electrocardiograma &#40;ECG&#41;&#44; es decir&#44; &#8805;<span class="elsevierStyleHsp" style=""></span>470<span class="elsevierStyleHsp" style=""></span>milisegundos &#40;ms&#41; en mujeres y &#8805;<span class="elsevierStyleHsp" style=""></span>450<span class="elsevierStyleHsp" style=""></span>ms en varones<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a>&#46; El SQTLA inducido por f&#225;rmacos ha servido durante mucho tiempo como indicador de un mayor riesgo de arritmias ventriculares&#44; como la taquicardia ventricular polim&#243;rfica &#40;Torsade de Pointes&#41;&#44; asoci&#225;ndose a un aumento de la mortalidad&#46; Dentro de las causas farmacol&#243;gicas m&#225;s frecuentes encontramos los f&#225;rmacos&#44; a destacar en poblaci&#243;n anciana los neurol&#233;pticos o antipsic&#243;ticos&#44; los antiarr&#237;tmicos o los antibi&#243;ticos<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">La presente carta cient&#237;fica tiene como objetivo describir una muestra de poblaci&#243;n geri&#225;trica que present&#243; prolongaci&#243;n del QT tras el tratamiento por infecci&#243;n por SARS-CoV-2 en funci&#243;n de la valoraci&#243;n geri&#225;trica integral y su asociaci&#243;n con mortalidad&#46; Se incluyeron pacientes mayores de 75 a&#241;os ingresados en una Unidad COVID-19 de Geriatr&#237;a &#40;UCG&#41; desde el 20 de marzo hasta el 31 de mayo de 2020 con diagn&#243;stico de infecci&#243;n por SARS-CoV-2 mediante confirmaci&#243;n con PCR o con alta sospecha cl&#237;nica-radiol&#243;gica&#46; Se analizaron todos aquellos pacientes con registro de ECG considerando la medici&#243;n del intervalo QT a las 48<span class="elsevierStyleHsp" style=""></span>h de iniciar cualquier tipo de tratamiento m&#233;dico para el SARS-CoV-2&#46; El QT corregido fue calculado usando la f&#243;rmula de Bazett&#44; consider&#225;ndose un QT corregido alargado &#8805;<span class="elsevierStyleHsp" style=""></span>470<span class="elsevierStyleHsp" style=""></span>ms para mujeres y &#8805;<span class="elsevierStyleHsp" style=""></span>450<span class="elsevierStyleHsp" style=""></span>ms para hombres&#46; Se analizaron variables como la funci&#243;n f&#237;sica&#44; mental&#44; la comorbilidad &#40;&#237;ndice de Charlson&#58; alta comorbilidad&#44; &#8805;<span class="elsevierStyleHsp" style=""></span>3&#41;&#44; polifarmacia &#40;en n&#250;mero &#91;&#8805;<span class="elsevierStyleHsp" style=""></span>5 y extrema &#8805;<span class="elsevierStyleHsp" style=""></span>10&#93; y tipolog&#237;a de f&#225;rmacos&#41;&#44; la mortalidad y el riesgo de mortalidad asociado a sepsis &#40;QSOFA<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>2&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Los resultados &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41; evaluaron un total de 71 individuos con registro de ECG&#46; La edad media fue de 85&#44;55<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;85 a&#241;os&#59; 66&#44;2&#37; mujeres&#46; Un 23&#44;9&#37; presentaba un alargamiento del QT &#40;8 mujeres y 9 hombres&#41;&#46; El QT promedio fue de 428&#44;57<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>47&#44;46<span class="elsevierStyleHsp" style=""></span>ms &#40;228-565<span class="elsevierStyleHsp" style=""></span>ms&#41; a las 48<span class="elsevierStyleHsp" style=""></span>h de haber iniciado cualquier tipo de terapia para la infecci&#243;n por SARS-CoV-2&#46; En cuanto al ritmo cardiaco de la muestra&#44; el 85&#44;9&#37; se encontraba en ritmo sinusal&#44; el 11&#44;3&#37; en fibrilaci&#243;n auricular y el 2&#44;8&#37; en ritmo de marcapasos&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">La mayor&#237;a de los pacientes proced&#237;an de centros residenciales &#40;80&#44;3&#37;&#41;&#46; Un 64&#44;8&#37; presentaba criterios de fragilidad grave y un 71&#44;9&#37; polifarmacia&#44; destacando benzodiacepinas &#40;36&#44;6&#37;&#41;&#44; quetiapina &#40;9&#44;9&#37;&#41; y antidepresivos &#40;35&#44;2&#37;&#41;&#46; En relaci&#243;n con el tratamiento del SARS-CoV-2&#58; el 91&#44;5&#37; recibi&#243; HQ&#44; el 59&#44;2&#37; AZ y el 15&#44;5&#37; LR&#46; La combinaci&#243;n m&#225;s frecuente fue HQ con AZ &#40;52&#44;1&#37;&#41;&#44; seguida de HQ con LR con un 16&#44;9&#37;&#46; La triple terapia de HQ<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>AZ<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>LR solamente se prescribi&#243; en un 4&#44;2&#37; &#40;3 pacientes&#41;&#46; Un 46&#44;4&#37; recibi&#243; corticoterapia y un 21&#44;1&#37; presentaba un QSOFA<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>2&#46; La mortalidad intrahospitalaria fue del 31&#44;9&#37;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">En el an&#225;lisis univariante &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41; solo el sexo masculino asoci&#243; una tendencia a presentar un QT prolongado&#59; el resto de variables&#44; incluida la mortalidad&#44; no obtuvieron asociaci&#243;n estad&#237;sticamente significativa en el an&#225;lisis&#44; a diferencia de otros estudios en los que la edad avanzada&#44; las diferentes comorbilidades y la polifarmacia se relacionaron con interacciones potenciales&#44; en particular con LR<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a>&#46; A pesar de las limitaciones de nuestro estudio&#44; con un tama&#241;o muestral peque&#241;o y no multic&#233;ntrico&#44; nos gustar&#237;a resaltar la tendencia a que en nuestro medio&#44; en una poblaci&#243;n geri&#225;trica habitual &#40;alta fragilidad&#44; polifarmacia&#44; comorbilidad&#41;&#44; los tratamientos habituales para el SARS-CoV-2 no se asociaron a una importante prolongaci&#243;n del intervalo QT ni tampoco a un aumento de la mortalidad que supusieran una invalidaci&#243;n de su uso y por tanto pueden considerarse&#44; de manera individualizada y con precauci&#243;n&#44; como herramienta terap&#233;utica para estos&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financiaci&#243;n</span><p id="par0035" class="elsevierStylePara elsevierViewall">La presente investigaci&#243;n no&#160;ha recibido ayudas espec&#237;ficas provenientes de agencias del&#160;sector&#160;p&#250;blico&#44; sector comercial o entidades sin &#225;nimo de lucro&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicto de intereses</span><p id="par0040" class="elsevierStylePara elsevierViewall">No existen conflictos de inter&#233;s por parte de ninguno de los autores&#46;</p></span></span>"
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Información del artículo
ISSN: 00257753
Idioma original: Español
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