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Sinus bradycardia is associated with poor outcome in critically ill patients with COVID-19 due to the B.1.1.7 Lineage

  • Chalkias, Athanasios1, 2
  • Pantazopoulos, Ioannis3
  • Papagiannakis, Nikolaos4
  • Skoulakis, Anargyros1
  • Laou, Eleni1
  • Kolonia, Konstantina1
  • Ntalarizou, Nicoletta1
  • Tourlakopoulos, Konstantinos5
  • Pagonis, Athanasios5
  • Kampolis, Christos6
  • De Guadiana Romualdo, Luis García7
  • Ragias, Dimitrios1
  • Eugen-Olsen, Jesper8
  • Gourgoulianis, Konstantinos5
  • Arnaoutoglou, Eleni1
  • 1 University of Thessaly, School of Health Sciences, Faculty of Medicine, Department of Anesthesiology, Larisa, Greece
  • 2 Outcomes Research Consortium, Cleveland, OH, 44195, USA
  • 3 University of Thessaly, School of Health Sciences, Faculty of Medicine, Department of Emergency Medicine, Larisa, Greece
  • 4 National and Kapodistrian University of Athens, Medical School, Eginition University Hospital, First Department of Neurology, Athens, Greece
  • 5 University of Thessaly, School of Health Sciences, Faculty of Medicine, Department of Respiratory Medicine, Larisa, Greece
  • 6 Hippokrateion University Hospital, Department of Emergency Medicine, Athens, Greece
  • 7 Hospital Universitario Santa Lucía, Laboratory Medicine Department, Cartagena, Spain
  • 8 Copenhagen University Hospital Hvidovre, Department of Clinical Research, Hvidovre, Denmark
Published Article
Toxicology Reports
Elsevier BV
Publication Date
Jul 08, 2021
DOI: 10.1016/j.toxrep.2021.07.004
PMID: 34258235
PMCID: PMC8265186
PubMed Central
  • Regular Article


The progress of COVID-19 from moderate to severe may be precipitous, while the characteristics of the disease are heterogenous. The aim of this study was to describe the development of sinus bradycardia in critically ill patients with COVID-19 and its association with outcome in outbreak due to the SARS-CoV-2 B.1.1.7 Lineage. We leveraged the multi-center SuPAR in Adult Patients With COVID-19 (SPARCOL) study and identified patients who required admission to intensive care unit (ICU). Inclusion criteria were: (a) adult (≥18 years old) patients hospitalized primarily for COVID-19; (b) a confirmed SARS-CoV-2 infection diagnosed through reverse transcriptase polymerase chain reaction test of nasopharyngeal or oropharyngeal samples; and (c) at least one blood sample collected at admission and stored for suPAR, hs-CRP, and ferritin testing. All patients had continuous heart rate monitoring during hospitalization. In total, 81 patients were included. Of them, 17 (21 %) and 64 (79 %) were intubated and admitted to the ICU during the first and second wave, respectively. Two (12 %) and 62 (97 %) developed bradycardia before ICU admission, respectively (p < 0.001). Patients with bradycardia had increased suPAR (p < 0.001) and hs-CRP level (p < 0.001). Infusion of isoprenaline and/or noradrenaline was necessary to maintain an adequate rate and peripheral perfusion in all patients. Mortality was significantly higher in patients with bradycardia (p < 0.001). In conclusion, bradycardia was associated with poor outcome. As B.1.1.7 variant strain is spreading more rapidly in many countries, our findings help in the identification of patients who may require early admission to ICU.

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