This study included 322 patients with COVID-19 including ambulatory and hospitalized patients who were considered for a 5-day course of remdesivir therapy. After excluding patients who could not fulfilled inclusion criteria, 249 patients consisted of 95 hospitalized and 154 ambulatory patients were included in the study (Fig. 1). The mean age of study population was 48.70 ± 14.50 years (range 17–95 years). The mean BMI was 28.01 4.30 kg/m2 (range 15.94–42.06 kg/m2). The demographic variables, mean LVEF, and coronary artery disease (CAD) risk factors of the study population are presented in Table 1. The most common CAD risk factor among study population was DM (47 patients, 18.9%) that was followed by HTN (45 patients, 18.1%), cigarette smoking (21 patients, 8.4%), and HLP (18 patients, 7.2%). In addition to remdesivir, these medications were used during hospitalization: heparin (95 patients, 38.2%), furosemide (92 patients, 36.9%), cephalosporin (88 patients, 35.3%), dexamethasone (83 patients (33.3%), insulin (41 patients, 16.5%), interferon (32 patients, 12.9%), famotidine (19 patients, 7.6%), metformin (12 patients, 4.8%), fluoroquinolones (10 patients, 4%), asentra (9 patients, 3.6%), atorvastatin (9 patients, 3.6%), carvedilol (8 patients, 3.2%), losartan (6 patients, 2.4%), clindamycin (4 patients, 1.6%),and macrolide (3 patients, 1.2%). Table 2 compares clinical, laboratory and electrocardiographic variable of patients’ population before and after remdesivir therapy (at first and fifth days). The results of this analysis showed blood pressure and HR were lower and total white blood cells and neutrophil counts, FBS and Cr levels were higher at fifth day than first day of study (P value < 0.001). Furthermore, QT interval was more prolonged at fifth day compared with beginning of remdesivir therapy (379.51 ± 34.90ms vs. 366.72 ± 30.97ms, P value < 0.001). However, QTc was not significantly increased at fifth day in comparison with first day (402.37 ± 33.62ms vs. 400.76 ± 30.18ms, P value = 0.524). A QT interval of more than 400 ms was seen in 34 patients (13.7%) before remdesivir therapy that its prevalence increased to 65 patients (26.1%) at fifth day. The McNemar test showed this difference was statistically significant (P value < 0.001) (Table 3, Fig. 2). On the other hand, 119 patients (47.8%) had a QTc of more than 400 ms before remdesivir therapy with increasing its prevalence to 130 patients (52.2%) at fifth day. However, it was not statistically significant (P value = 0.329) (Table 3, Fig. 3). Univariate logistic regression analysis showed that increased HR was associated with a significant decrease in QT interval (B = 0.955, 95% CI: 0.933–0.977, P value < 0.001) (Table 4).
Table 1
The demographic variables, past medical history, and cardiovascular risk factors of the study population
| Mean ± SD or frequency (percentile) |
Age (years) | 48.70 ± 14.49 |
Body mass index (kg/m2) | 28.01 ± 4.30 |
Number of days of hospital stay (n = 95) | 8.94 ± 3.258 |
Left ventricular ejection fraction (%) | 56.85 ± 6.14 |
Sex (n, %) | Male | 117 (47%) |
Female | 132 (53%) |
Diabetes mellitus (n, %) | 47 (18.9%) |
Hypertension (n, %) | 45 (18.1%) |
Hyperlipidemia (n, %) | 18 (7.2%) |
Smoking (n, %) | 21 (8.4%) |
History of percutaneous coronary intervention (n, %) | 10 (4%) |
History of coronary artery bypass graft (n, %) | 9 (3.6%) |
Table 2
Clinical, laboratory and electrocardiographic variable of patients’ population before and after remdesivir therapy (at first and fifth days).
| Pre remdesivir therapy (first day) | Post remdesivir therapy (fifth day) | P value |
Systolic blood pressure (mmHg) | 115.50 ± 12.153 | 113.67 ± 11.095 | < 0.001 |
Diastolic blood pressure (mmHg) | 73.12 ± 8.343 | 71.51 ± 10.919 | < 0.001 |
Heart rate (bpm) | 79.45 ± 12.847 | 73.06 ± 13.394 | < 0.001 |
Hemoglobin (g/dl) | 12.96 ± 1.84 | 13.49 ± 2.0752 | < 0.001 |
WBC (103xmm3) | 8.21 ± 3.26 | (9.971 ± 3.57 | < 0.001 |
Neutrophil (%) | 77.86 ± 9.84 | 81.70 ± 8.69 | 0.001 |
Lymph (%) | 17.33 ± 9.447 | 12.29 ± 6.974 | < 0.001 |
Fasting blood sugar (mg/dl) | 191.43 ± 102.13 | 271.04 ± 92.50 | < 0.001 |
Serum creatinine (mg/dl) | 1.11 ± 0.50 | 1.13 ± 0.36 | < 0.001 |
QT interval (ms) | 366.72 ± 30.97 | 379.51 ± 34.90 | < 0.001 |
QT interval ≥ 400ms | 34 (13.7%) | 65 (26.1%) | < 0.001 |
Corrected QT interval (ms) | 400.76 ± 30.18 | 402.37 ± 33.62 | 0.524 |
Corrected QT interval ≥ 400ms | 119 (47.8%) | 130 (52.2%) | 0.329 |
Blood sodium level (meq/l) | 139.01 ± 4.11 | 137.01 ± 3.97 | < 0.001 |
Blood potassium level (meq/l) | 4.16 ± 0.42 | 3.90 ± 0.53 | 0.008 |
Table 3
The McNemar test for comparing prevalence of QT and corrected QT interval of more than 400 ms before and after remdesivir therapy (first and fifth days)
First day QT interval ≥ 400ms | Fifth day QT interval ≥ 400ms | | | |
no | yes | N | 249 |
no | 167 | 48 | Chi-Square | 13.846 |
yes | 17 | 17 | Asymp. Sig. | .000 |
First day corrected QT interval ≥ 400ms | Fifth day corrected QT interval ≥ 400ms | | | |
no | yes | N | 249 |
no | 72 | 58 | Chi-Square | .952 |
yes | 47 | 72 | Asymp. Sig. | .329 |
Table 4
Univariate logistic regression analysis determining relationship between heart rate and QT interval at fifth day of remdesivir therapy
| B | S.E. | Wald | df | Sig. | Exp(B) | 95% C.I.for EXP(B) |
Lower | Upper |
Step 1a | Heart rate at fifth day | − .046 | .012 | 15.536 | 1 | .000 | .955 | .933 | .977 |
Constant | 2.241 | .826 | 7.358 | 1 | .007 | 9.405 | | |