KOMPLIKASI ARITMIA DAN LUARANNYA PADA PASIEN COVID-19: TELAAH SISTEMATIS DAN META-ANALISIS
DOI:
https://doi.org/10.24269/ijhs.v5i2.3822Abstract
Beberapa  studi menunjukkan bahwa COVID-19 menyebabkan terjadinya ke-rusakan pada jantung dan badai sitokin di dalam tubuh, yang memicu timbulnya aritmia. Tulisan ini bertujuan untuk melakukan telaah sistematis dan meta análisis terhadap insidensi aritmia dan luarannya pada pasien COVID-19. Kami mencari jurnal penelitian yang memuat informasi tentang aritmia sebagai komplikasi COVID-19 dan status luaran pasien; luaran buruk (dengan gejala berat, mengalami kematian, atau menjalani perawatan di Intensive Care Unit (ICU)) dan tanpa luaran buruk dengan kata kunci “COVID-19†atau “SARS-Cov-2†atau “Coronavirus†dan “Aritmia†atau “Kardiovaskular†atau “Karakteristikâ€. Sebanyak 5 jurnal dipilih untuk dilakukan telaah sistematis dan meta-analisis. Terdapat 1.301 pasien sebagai sampel. Insidensi aritmia pada pasien COVID-19 adalah 11% (8-15%; I2: 71.22, p = 0,01); pada pasien dengan luaran buruk adalah 35% (17-52%; I2: 92.90, p = 0,00); dan pada pasien tanpa luaran buruk adalah 3% (1-5%; I2: 54.27, p = 0,07). Pasien COVID-19 yang mengalami aritmia memiliki resiko luaran buruk yang lebih besar (RR 5.54 [4.59, 6.68]; I2: 87.3, p < 0,001). Analisis dengan funnel plot menandakan terdapat bias publikasi. Uji regresi dengan Egger’s test menunjukkan tidak adanya small study effects (p = 0,352). Terdapat hubungan yang signifikan antara kejadian aritmia dengan peningkatan resiko luaran buruk pada pasien COVID-19.
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[25] Oudit GY, Kassiri Z, Jiang C, Liu PP, Poutanen SM, Penninger JM, et al. SARS-coronavirus modulation of myocardial ACE2 expression and inflammation in patients with SARS. Eur J Clin Invest. 2009;39:618–25. https://doi.org/10.1111/j.1365-2362. 2009.02153.x
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[30] Kapoor A, Pandurangi U, Arora V, Gupta A, Jaswal A, Yadav R, et al. Cardiovascular risks of hydroxychloroquine in treatment and prophylaxis of COVID-19 patients : A scientific statement from the Indian Heart Rhythm Society. Indian Pacing Electrophysiol J [Online]. 2020;20(3):117–20. Available from: https://doi.org/10.1016/j.ipej.2020.04.003
[31] Hancox JC, Hasnain M, Vieweg WVR, Crouse ELB, Baranchuk A. Azithromycin , cardiovascular risks , QTc interval prolongation , torsade de pointes , and regulatory issues : A narrative review based on the study of case reports. Ther Adv Infect Dis. 2013;1(5):155–66. https://doi.org /10.1177/2049936113501816
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[34] Food and Drug Association. Zithromax®(azithromycin tablets) and (azithromycin for oral suspension). Silver Spring. 2012
[2] Worldometer. COVID-19 CORONAVIRUS PANDEMIC [Internet]. 2021 [cited 2021 Apr 24]. Available from: https://www.worldo meters.info/coronavirus/
[3] Huang I, Pranata R. Lymphopenia in severe coronavirus disease-2019 ( COVID-19 ): systematic review and meta-analysis. J Intensive Care. 2020;8(36):1–10. https://doi.org/10. 20201186/s40560-020-00453-4%20
[4] Huang I, Lim MA, Pranata R. Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia - A systematic review, meta- analysis, and meta-regression. Diabetes Metab Syndr Clin Res Rev. 2020;14(4). https://doi.org/10.1016/j.dsx.2020.04.018
[5] Pranata R, Lim MA, Huang I, Raharjo SB, Lukito AA. Hypertension is associated with increased mortality and severity of disease in COVID-19 pneumonia : A systematic review , meta-analysis and meta-regression. J Renin-Angiotensin-Aldosterone Syst. 2020;21(2). https://doi.org/10.1177/ 1470320320926899
[6] Pranata R, Harapan UP, Soeroto AY, Hospital HS, Lim MA, Harapan UP, et al. Effect of chronic obstructive pulmonary disease and smoking on the outcome of COVID-19. Int J Tuberc Lung Dis. 2020;24(8). https://doi.org/10.5588/ijtld.20.0278
[7] Pranata R, Huang I, Lim MA, Wahjoepramono EJ, July J. Impact of cerebrovascular and cardiovascular diseases on mortality and severity of COVID-19-systematic review, meta- analysis, and meta-regression. J Stroke Cerebrovasc Dis. 2020;29(8). https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104949
[8] Shi, S., Qin, M., Shen, B., Cai, Y., Liu, T., Yang, F., Gong, W., Liu, X., Liang, J., Zhao, Q. and Huang H. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan. JAMA Cardiol. 2020;5(7):802–10. https:// doi.org/10.1001/jamacardio.2020.0950
[9] Lazzerini PE, Boutjdir M, Capecchi PL. COVID-19, Arrhythmic Risk, and Inflammation. Circ J. 2020;142(1):7–9. https://doi.org/10. 1161/circulationaha.120.047293
[10] Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus – Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11) :1061–9. https://doi. org/10.1001/jama.2020.1585
[11] Cao J, Tu W-J, Cheng W, Yu L, Liu Y-K, Hu X, et al. Clinical Features and Short-term Outcomes of 102 Patients with Corona Virus Disease 2019 in Wuhan, China. Clin Infect Dis an Off Publ Infect Dis Soc Am. 2020;71(15):748–55. https://doi.org/ 10.1093/cid/ciaa243
[12] Bhatla A, Mayer MM, Adusumalli S, Hyman MC, Oh E, Tierney A, et al. COVID-19 and cardiac arrhythmias. Hear Rhytm. 2020;17(9):1439–44. https://doi.org/ 10.1016/j.hrthm.2020.06.016
[13] Turagam MK, Musikantow D, Goldman ME, Bassily-Marcus A, Chu E, Shivamurthy P, et al. Malignant Arrhythmias in Patients With COVID-19. Circ Arrhythmia Electrophysiol Orig. 2020;13(11) :1321–30. https://doi.org/10.1161/ circep.120.008920
[14] Zhang G, Hu C, Luo L, Fang F, Chen Y, Li J, et al. Clinical features and outcomes of 221 patients with COVID-19 in Wuhan, China. J Clin Virol. 2020;127(June 2020). https:// doi.org/10.1016/j.jcv.2020.104364
[15] Driggin E, Madhavan M V, Bikdeli B, Chuich T, Harm PD. Cardiovascular considerations for patients, health care workers, and health systems during the coronavirus disease 2019 (COVID-19) pandemic. J Am Coll Cardiol. 2020;75(18):2352–71. https://doi.org /10.1016/j.jacc.2020.03.031
[16] Huang I, Pranata R, Lim MA, Oehadian A, Alisjahbana B. C-reactive protein, procalcitonin, D-dimer, and ferritin in severe coronavirus disease-2019: a meta-analysis. Ther Adv Respir Dis. 2020;14:1–14. https://doi.org/10. 1177/1753466620937175
[17] Lim MA, Pranata R, Huang I, Yonas E, Soeroto AY, Supriyadi R. Multiorgan Failure With Emphasis on Acute Kidney Injury and Severity of COVID-19: Systematic Review and Meta-Analysis. Can J Kidney Heal Dis. 2020;7:1–12. https://doi. org/10.1177/2054358120938573
[18] Yang C, Jin Z. An Acute Respiratory Infection Runs Into the Most Common Noncommunicable Epidemic—COVID-19 and Cardiovascular Diseases. JAMA Cardiol. 2020;5(7):743–4. https:// doi.org/10.1001/jamacardio.2020.0934
[19] Lakkireddy DR, Chung MK, Russo AM. Guidance for Cardiac Electrophysiology During the COVID-19 Pandemic from the Heart Rhythm Society COVID-19 Task Force; Electrophysiology Section of the American College of Cardiology; and the Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, American Heart Association. Circulation. 2020;141(21):823–31. https://doi.org/10.1016/j.hrthm.2020.03.028
[20] Kochi AN, Forleo GB, Tondo C, Tagliari AP, Fassini GM. Cardiac and arrhythmic complications in patients with COVID †19. J Cardiovasc Electrophysiol. 2020;31(5):1003–8. https://doi.org /10.1111/jce.14479
[21] Pranata R, Huang I, Lukito AA, Raharjo SB. Elevated N-Terminal pro-brain natriuretic peptide is associated with increased mortality in patients with COVID-19: Systematic review and meta-Analysis. Postgrad Med J. 2020;96(1137):387–91. https://doi. org/10.1136/postgradmedj-2020-137884
[22] Babapoor-farrokhran S, Gill D, Walker J, Rasekhi RT. Myocardial injury and COVID-19: Possible mechanisms. Life Sci. 2020;253(July):1–5. https://doi.org /10.1016/j.lfs.2020.117723
[23] Azevedo RB, Botelho BG, Hollanda JVG de, Ferreira LVL, Junqueira de Andrade LZ, Oei SSML, et al. Covid-19 and the cardiovascular system: a comprehensive review. J Hum Hypertens [Online]. 2021;35(1):4–11. https://doi.org/ 10.1038/s41371-020-0387-4
[24] Hu H, Ma F, Wei X, Fang Y. Coronavirus fulminant myocarditis treated with glucocorticoid and human immunoglobulin. Eur Heart J. 2021;42(2):206. https://doi.org/10. 1093/eurheartj/ehaa190
[25] Oudit GY, Kassiri Z, Jiang C, Liu PP, Poutanen SM, Penninger JM, et al. SARS-coronavirus modulation of myocardial ACE2 expression and inflammation in patients with SARS. Eur J Clin Invest. 2009;39:618–25. https://doi.org/10.1111/j.1365-2362. 2009.02153.x
[26] Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506. https://doi.org/10.1016/s0140-6736 (20)30183-5
[27] Cameron MJ, Bermejo-martin JF, Danesh A, Muller MP, Kelvin DJ. Human immunopathogenesis of severe acute respiratory syndrome (SARS). Virus Res. 2008;133(1):13–9. https://doi.org/10.1016/j.virusres. 2007.02.014
[28] Wong CK, Lam CWK, Wu AKL, Ip WK, Lee NLS, Chan IHS, et al. Plasma inflammatory cytokines and chemokines in severe acute respiratory. Clin Exp Immunol. 2004;136(1):95–103. https://doi.org /10.1111/j.1365-2249.2004.02415.x
[29] Tse G, Yeo JM, Chan YW, Lai ETH, Yan BP, Walton RD, et al. What Is the Arrhythmic Substrate in Viral Myocarditis ? Insights from Clinical and Animal Studies. Card Electrophysiol. 2016;7(July). https:// doi.org/10.3389/fphys.2016.00308
[30] Kapoor A, Pandurangi U, Arora V, Gupta A, Jaswal A, Yadav R, et al. Cardiovascular risks of hydroxychloroquine in treatment and prophylaxis of COVID-19 patients : A scientific statement from the Indian Heart Rhythm Society. Indian Pacing Electrophysiol J [Online]. 2020;20(3):117–20. Available from: https://doi.org/10.1016/j.ipej.2020.04.003
[31] Hancox JC, Hasnain M, Vieweg WVR, Crouse ELB, Baranchuk A. Azithromycin , cardiovascular risks , QTc interval prolongation , torsade de pointes , and regulatory issues : A narrative review based on the study of case reports. Ther Adv Infect Dis. 2013;1(5):155–66. https://doi.org /10.1177/2049936113501816
[32] Ray WA, Murray KT, Hall K, Arbogast PG, Stein CM. Azithromycin and the Risk of Cardiovascular Death. N Engl J Med. 2012;366(20):1881–90. https:// www.doi.org/10.1056/NEJMoa1003833
[33] Mosholder AD, Mathew J, Alexander JJ, Smith H, Nambiar S. Cardiovascular Risks with Azithromycin and Other Antibacterial Drugs. N Engl J Med. 2012;366(18):1665–8. https://doi. org/10.1056/nejmp1302726
[34] Food and Drug Association. Zithromax®(azithromycin tablets) and (azithromycin for oral suspension). Silver Spring. 2012
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