Diabetes mellitus and QTc prolonging medications usage increased the
risk of QTc prolongation during long-term hydroxychloroquine use- A
databank based retrospective cohort study
Abstract
Abstract Background Hydroxychloroquine plays a role in antimalaria,
immune modulation, and possible novel coronavirus-2019 activity in
vitro. The unwanted effect on QT prolongation could lead to lethal
arrhythmia. Recently, American College of Cardiology (ACC) had
announced to use a risk score system while treating patients with
hydroxychloroquine. In this study, we investigated the possible risk
factors of corrected QT (QTc) prolongation and validated the
applicability of ACC risk score system in our cohort. Methods We
retrospectively enrolled 4568 patients who had undergone long-term
hydroxychloroquine. 167 patients had electrocardiography before and
during hydroxychloroquine use. All baseline characteristics, laboratory
data, comorbidities, and concurrent medications were all recorded.
Results The majority (80.8%) of our cohort were female and the average
age was 51.4 years old. The most common indication of hydroxychloroquine
is an autoimmune disease (95.2%), and the average dosage was 315mg
daily. In multivariable logistic regression, diabetes mellitus (OR,
9.286, 95% CI=2.026-45.22) and additional QTc prolonging medications
(OR, 2.89, 95% CI=1.40-5.94) were stronger independent risk factors
than ACC risk score (OR, 1.20, 95% CI=1.02-1.41) for QTc
prolongation≧60 ms. In linear regression, comorbidities and QTc
prolonging medications (Adjusted R2: 0.385) provided more accurate
prediction of QTc response than the ACC risk score alone (Adjusted R2:
0.259). Conclusions For those patients with long-term hydroxychloroquine
use, patients with DM and additional QTc prolonging medications were
more susceptible to significant QTc prolongation. Patient’s baseline QTc
interval, concurrent medications and comorbidities, rather than the ACC
risk score, could be used to predict the response of QTc.