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Pantazopoulos I, Mavrovounis G, Dimeas G, Zikos N, Pitsikou M, Rousogianni E, Mermiri M, Michou A, Spanos M, Maniotis C, Chalkias A, Laou E, Zakynthinos G, Chatzis D, Gourgoulianis K. Remdesivir-induced Bradycardia is not Associated with Worse Outcome in Patients with COVID-19: A Retrospective Analysis. Am J Cardiovasc Drugs 2022; 22:705-710. [PMID: 36002783 PMCID: PMC9402406 DOI: 10.1007/s40256-022-00547-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2022] [Indexed: 12/20/2022]
Abstract
Background COVID-19, is primarily a respiratory illness but is known to cause extrapulmonary manifestations, especially on the cardiovascular system. Bradycardia is commonly reported in COVID-19 patients despite no prior history of occurrence, and many studies have shown an association with increased mortality. Multiple case reports have been published showcasing remdesivir potentially causing bradycardia. Our aim was to investigate the incidence of bradycardia in patients receiving remdesivir and examine the association with disease severity and survival outcomes. Methods A retrospective study was performed including 160 COVID-19 patients receiving remdesivir for 5 days. Patients’ demographics, comorbidities, medication, vital signs, laboratory tests and outcome were recorded. Bradycardia was defined as a heart rate < 60 beats/min and severe bradycardia < 50 beats/min. Results One hundred eighteen (73.8%) patients experienced at least one episode of bradycardia during hospitalisation. Bradycardia was present in 12 (7.5%) patients before treatment with remdesivir. The rate of bradycardia increased up to the 6th day of hospitalisation (40.6%) and subsequently diminished and normalised within 5 days after the last remdesivir dose (5% at Day 10). Severe bradycardia was observed in 13 (7.5%) patients. No difference was observed in ICU admission between groups (bradycardia vs no bradycardia). When we stratified patients according to the outcome of hospitalisation, no significant difference was observed in the occurrence of bradycardia between groups (alive vs dead) [p = 0.853]. Conclusions Treatment with remdesivir may be associated with new-onset bradycardia in hospitalised patients with COVID-19. However, bradycardia is transient and is not associated with ICU admission and mortality.
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Affiliation(s)
- Ioannis Pantazopoulos
- Department of Emergency Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500, Larissa, Greece.
| | - Georgios Mavrovounis
- Department of Emergency Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500, Larissa, Greece
| | - Georgios Dimeas
- Department of Emergency Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500, Larissa, Greece
| | - Nikolaos Zikos
- Department of Emergency Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500, Larissa, Greece
| | - Maria Pitsikou
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500, Larissa, Greece
| | - Eleni Rousogianni
- Department of Emergency Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500, Larissa, Greece
| | - Maria Mermiri
- Department of Anaesthesiology, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500, Larissa, Greece
| | - Anastasia Michou
- Department of Anaesthesiology, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500, Larissa, Greece
| | - Michalis Spanos
- Department of Emergency Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500, Larissa, Greece
| | | | - Athanasios Chalkias
- Department of Anaesthesiology, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500, Larissa, Greece
| | - Eleni Laou
- Department of Anaesthesiology, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500, Larissa, Greece
| | | | | | - Konstantinos Gourgoulianis
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500, Larissa, Greece
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Schreiber A, Bauzon JS, Batra K, Mohammed S, Lee K, Houshmand N, Pham U, Cosme C, Inciong K, Al-Taweel O, Nasser K, Rana J, Sossou C, Go A, Hawwass D, Diep J, Ahsan CH. Clinical Characteristics and Implications of Bradycardia in COVID-19 Patients Treated with Remdesivir: A Single-Center Retrospective Cohort Study. Clin Drug Investig 2022; 42:763-774. [PMID: 35978159 PMCID: PMC9385079 DOI: 10.1007/s40261-022-01187-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 12/15/2022]
Abstract
Background and Objectives Remdesivir is an antiviral drug used to treat coronavirus disease 2019 (COVID-19) with a relatively obscure cardiac effect profile. Previous studies have reported bradycardia associated with remdesivir, but few have examined its clinical characteristics. The objective of this study was to investigate remdesivir associated bradycardia and its associated clinical characteristics and outcomes. Methods This is a single-institution retrospective study that investigated bradycardia in 600 patients who received remdesivir for treatment of COVID-19. A total of 375 patients were included in the study after screening for other known causes of bradycardia (atrioventricular [AV] nodal blockers). All patients were analyzed for episodes of bradycardia from when remdesivir was initiated up to 5 days after completion, a time frame based on the drug’s putative elimination half-life. Univariate and multivariate statistical tests were conducted to analyze the data. Results The mean age of the sample was 56.63 ± 13.23 years. Of patients who met inclusion criteria, 49% were found to have bradycardia within 5 days of remdesivir administration. Compared to the cohort without a documented bradycardic episode, patients with bradycardia were significantly more likely to experience inpatient mortality (22% vs 12%, p = 0.01). The patients with bradycardia were found to have marginally higher serum D-dimer levels (5.2 vs 3.4 µg/mL, p = 0.05) and were more likely to undergo endotracheal intubation (28% vs 14%, p = 0.008). Male sex, hyperlipidemia, and bradycardia within 5 days of completing remdesivir were significant predictors of inpatient mortality. No significant differences in length of stay were found. Conclusions Bradycardia that occurs during or shortly after remdesivir treatment in COVID-19 patients may be associated with an increased rate of in-hospital mortality. However, COVID-19 and its cardiac complications cannot be excluded as potential contributors of bradycardia in the present study. Future studies are needed to further delineate the cardiac characteristics of COVID-19 and remdesivir. Supplementary Information The online version contains supplementary material available at 10.1007/s40261-022-01187-x.
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Affiliation(s)
- Ariyon Schreiber
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas (UNLV), 2040 W. Charleston Blvd., Mail Stop: 3070, Las Vegas, NV, 89102-2244, USA.
| | - Justin S Bauzon
- Department of Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada, USA
| | - Kavita Batra
- Department of Medical Education & Office of Research, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada, USA
| | - Salman Mohammed
- Department of Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada, USA
| | - Kevin Lee
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas (UNLV), 2040 W. Charleston Blvd., Mail Stop: 3070, Las Vegas, NV, 89102-2244, USA
| | - Nazanin Houshmand
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas (UNLV), 2040 W. Charleston Blvd., Mail Stop: 3070, Las Vegas, NV, 89102-2244, USA
| | - Uyen Pham
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas (UNLV), 2040 W. Charleston Blvd., Mail Stop: 3070, Las Vegas, NV, 89102-2244, USA
| | - Celica Cosme
- Department of Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada, USA
| | - Kim Inciong
- Department of Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada, USA
| | - Omar Al-Taweel
- Department of Cardiology, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada, USA
| | - Keaton Nasser
- Department of Cardiology, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada, USA
| | - Jibran Rana
- Department of Cardiology, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada, USA
| | - Chris Sossou
- Department of Cardiology, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada, USA
| | - Ariel Go
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas (UNLV), 2040 W. Charleston Blvd., Mail Stop: 3070, Las Vegas, NV, 89102-2244, USA
| | - Dalia Hawwass
- Department of Cardiology, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada, USA
| | - Jimmy Diep
- Department of Cardiology, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada, USA
| | - Chowdhury H Ahsan
- Department of Cardiology, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada, USA
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Tajarernmuang P, Trongtrakul K, Chaiwong W, Nantsupawat T, Deesomchok A, Chanayat P, Niyatiwatchanchai N, Theerakittikul T, Limsukon A, Pothirat C, Liwsrisakun C, Bumroongkit C. Bradycardia and Heart Rate Fluctuation Are Associated with a Prolonged Intensive Care Unit Stay in Patients with Severe COVID-19. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58070950. [PMID: 35888669 PMCID: PMC9319932 DOI: 10.3390/medicina58070950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 12/15/2022]
Abstract
Background and Objective: Bradycardia has been observed among patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is suspected to be associated with poorer outcomes. Heart rate (HR) fluctuation has been found to be correlated with a greater mortality rate in critically ill patients. The association of bradycardia and HR fluctuation with the outcome of severe coronavirus disease 2019 (COVID-19) patients has not been clarified. Therefore, we aimed to examine whether bradycardia and HR fluctuation correlated with poor outcomes in patients with severe COVID-19. Materials and Methods: We conducted a secondary analysis from a prospective data collection of patients admitted to the intensive care unit, between April and June 2021, at Chiang Mai University Hospital. Results: The results showed that 62 of 86 patients (72.1%) had bradycardia, defined by HR < 60 beats per minute (bpm). The number of patients with high HR fluctuation, defined as the difference in HR during admission ≥ 40 bpm, was greater among the bradycardia group than in the non-bradycardia group (70.9% vs. 14.7%, p = 0.015, respectively). The patients with bradycardia had greater levels of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). In addition, a greater proportion of patients with bradycardia received interleukin-6 inhibitors and hemoperfusion as a rescue therapy than those with non-bradycardia. After adjusting for age, gender, body mass index, CRP, and mechanical ventilator; bradycardia and the high HR fluctuation were significantly associated with a longer length of stay in the intensive care unit (ICU-LOS), with adjusted risk ratios of 2.67, 95% CI; 1.02, 6.94, p = 0.045 and 2.88, 95% CI; 1.22, 6.78, p = 0.016, respectively. Conclusion: We found that bradycardia and a high heart rate fluctuation were associated with a poorer ICU outcome in terms of longer ICU-LOS among the patients with severe COVID-19.
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Affiliation(s)
- Pattraporn Tajarernmuang
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.T.); (W.C.); (A.D.); (P.C.); (N.N.); (T.T.); (A.L.); (C.P.); (C.L.); (C.B.)
| | - Konlawij Trongtrakul
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.T.); (W.C.); (A.D.); (P.C.); (N.N.); (T.T.); (A.L.); (C.P.); (C.L.); (C.B.)
- Correspondence: ; Tel.: +66-81-992-8133
| | - Warawut Chaiwong
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.T.); (W.C.); (A.D.); (P.C.); (N.N.); (T.T.); (A.L.); (C.P.); (C.L.); (C.B.)
| | - Teerapat Nantsupawat
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Athavudh Deesomchok
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.T.); (W.C.); (A.D.); (P.C.); (N.N.); (T.T.); (A.L.); (C.P.); (C.L.); (C.B.)
| | - Panida Chanayat
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.T.); (W.C.); (A.D.); (P.C.); (N.N.); (T.T.); (A.L.); (C.P.); (C.L.); (C.B.)
| | - Nutchanok Niyatiwatchanchai
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.T.); (W.C.); (A.D.); (P.C.); (N.N.); (T.T.); (A.L.); (C.P.); (C.L.); (C.B.)
| | - Theerakorn Theerakittikul
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.T.); (W.C.); (A.D.); (P.C.); (N.N.); (T.T.); (A.L.); (C.P.); (C.L.); (C.B.)
| | - Atikun Limsukon
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.T.); (W.C.); (A.D.); (P.C.); (N.N.); (T.T.); (A.L.); (C.P.); (C.L.); (C.B.)
| | - Chaicharn Pothirat
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.T.); (W.C.); (A.D.); (P.C.); (N.N.); (T.T.); (A.L.); (C.P.); (C.L.); (C.B.)
| | - Chalerm Liwsrisakun
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.T.); (W.C.); (A.D.); (P.C.); (N.N.); (T.T.); (A.L.); (C.P.); (C.L.); (C.B.)
| | - Chaiwat Bumroongkit
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.T.); (W.C.); (A.D.); (P.C.); (N.N.); (T.T.); (A.L.); (C.P.); (C.L.); (C.B.)
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Umeh CA, Kumar S, Wassel E, Barve P. Meta-analysis and systematic literature review of COVID-19 associated bradycardia as a predictor of mortality. Egypt Heart J 2022; 74:47. [PMID: 35665869 PMCID: PMC9166215 DOI: 10.1186/s43044-022-00284-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 05/20/2022] [Indexed: 11/28/2022] Open
Abstract
Background Cardiac arrhythmias have been identified as independent predictors of mortality in Coronavirus disease 2019 (COVID-19) patients. While some studies have reported poor prognosis with bradycardia in COVID-19 patients, others have not found any association between bradycardia and mortality in COVID-19 patients. This study aims to assess the relationship between bradycardia and mortality in COVID-19 patients by reviewing existing literature. Main body Articles were obtained by systematically searching the PubMed and Google scholar databases. Qualitative and quantitative analyses of the studies on bradycardia and mortality in COVID-19 were done. A pooled estimate, with a sample size of 1320 patients, comparing the effect of patients that were bradycardic during their admission with those that were not on mortality showed that bradycardia did not lead to increased mortality in COVID-19 patients (OR 1.25, 95% CI 0.41–3.84, p = 0.7). Conclusions This meta-analysis showed that bradycardia was not significantly associated with mortality in COVID-19 patients. However, this study is limited by the few studies on bradycardia and mortality in COVID-19 patients. Therefore, future studies should investigate this relationship so that clinicians can prognostically triage and treat COVID-19 patients appropriately.
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Affiliation(s)
- Chukwuemeka A Umeh
- Department of Internal Medicine, Hemet Global Medical Center, 1117 E. Devonshire Ave., Hemet, CA, 92543, USA.
| | - Sabina Kumar
- Department of Internal Medicine, Hemet Global Medical Center, 1117 E. Devonshire Ave., Hemet, CA, 92543, USA
| | - Elias Wassel
- Department of Internal Medicine, Hemet Global Medical Center, 1117 E. Devonshire Ave., Hemet, CA, 92543, USA.,St. George's University, School of Medicine, University Centre Grenada, West Indies, Grenada
| | - Pranav Barve
- Department of Internal Medicine, Hemet Global Medical Center, 1117 E. Devonshire Ave., Hemet, CA, 92543, USA
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Umeh C, Giberson C, Kumar S, Aseri M, Barve P. A Multicenter Retrospective Analysis on the Etiology of Bradycardia in COVID-19 Patients. Cureus 2022; 14:e21294. [PMID: 35186556 PMCID: PMC8846448 DOI: 10.7759/cureus.21294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2022] [Indexed: 02/06/2023] Open
Abstract
Introduction Bradycardia has been reported in the setting of SARS-CoV2 (COVID-19) and appears to be an important cardiac manifestation with an association of mortality. However, the etiology of bradycardia in COVID-19 remains unclear. Therefore, this study aims to retrospectively investigate the potential causes of bradycardia in COVID-19 patients. Method The multicenter retrospective analysis consisted of 1,116 COVID-19 positive patients from March 2020 to March 2021. Bradycardia and severe bradycardia were defined as a sustained heart rate of <60 BPM and <50 BPM, respectively, on two separate occasions, a minimum of four hours apart during the hospitalization. End-of-life bradycardia was excluded from the study. Data were retrieved using a structured query language (SQL) program through the EMR, and data were analyzed using IBM SPSS 27.0 (IBM Corp., Armonk, NY). Logistic regression was used to study the bradycardic event and its association with remdesivir, beta-blockers, or steroids use during the patient's hospital stay. Result In the multivariate analysis, bradycardia was significantly associated with length of hospital stay (p<0.001), mortality (p=0.022), ventilator use (p=0.001), and steroid use (p=0.001). However, there was no significant association between bradycardia and remdesivir use (p=0.066) or beta-blocker use (p=0.789). Conclusion Our study showed that steroid use was protective against developing bradycardia in COVID-19 patients. Furthermore, remdesivir and the use of beta-blockers were not associated with bradycardia in COVID-19 patients. However, bradycardia was associated with both increased mortality and length of stay in the hospital. Therefore, future studies should focus on the mechanism of bradycardia in COVID-19 patients and the effect of bradycardia on patient outcomes.
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Affiliation(s)
| | | | - Sabina Kumar
- Internal Medicine, Hemet Global Medical Center, Hemet, USA
| | - Mahendra Aseri
- Data Engineering and Business Intelligence, Hemet Global Medical Center, Hemet, USA
| | - Pranav Barve
- Internal Medicine, Hemet Global Medical Center, Hemet, USA
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Umeh C, Watanabe K, Tuscher L, Ranchithan S, Gupta R. Comparison of Clinical Characteristics and Outcomes of COVID-19 Between Young and Older Patients: A Multicenter, Retrospective Cohort Study. Cureus 2022; 14:e21785. [PMID: 35251855 PMCID: PMC8890849 DOI: 10.7759/cureus.21785] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 02/06/2023] Open
Abstract
Background Outcomes of coronavirus disease 2019 (COVID-19) have been reported to be different in the young and elderly populations. However, previous studies examining these characteristics and differences in outcomes between the two groups had a small sample size. Therefore, in this study, we evaluate the differences between young and elderly patients using a large multicenter dataset. Methodology We conducted a retrospective study of 1,116 consecutive COVID-19 patients admitted to two hospitals in southern California in the United States between March 2020 and March 2021. In this study, we categorized patients into two age groups: less than 65 years and 65 years and above. Finally, Kaplan-Meier and backward selection Cox multivariate regression analyses were done using mortality as the dependent variable. Results Our analysis showed increased survival in patients aged less than 65 years compared to those aged 65 years or above (p < 0.001). Furthermore, in patients aged 65 years and above, age (hazard ratio (HR) = 1.05; p < 0.001), C-reactive protein (CRP) (HR = 1.05; p < 0.001), and bradycardia (HR = 2.1; p < 0.001) were significantly associated with mortality. Similarly, CRP (HR 1.05; p = 0.02) was significantly associated with mortality in patients aged less than 65 years. However, contrary to many studies, being male (HR = 0.46; p = 0.002) was protective against mortality in patients aged less than 65 years. Conclusions Our study showed that the predictors of mortality in COVID-19 patients differed by age group. While age, CRP, and bradycardia were associated with mortality in those aged less than 65 years, only CRP was associated with mortality in those aged 65 years and above.
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Affiliation(s)
| | | | - Laura Tuscher
- Internal Medicine, Hemet Global Medical Center, Hemet, USA
| | - Sobiga Ranchithan
- Medicine and Surgery, American University of Antigua, St. John's, ATG
| | - Rahul Gupta
- Internal Medicine, Hemet Global Medical Center, Hemet, USA
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