The use of Tisdale risk score during hydroxychloroquine/chloroquine treatments on COVID-19 patients

Abstract

Background: The SARS-CoV-2 infection or COVID-19 disease caused significant morbidity and mortality. Early reports showed clinical improvement with hydroxychloroquine (HCQ) and chloroquine (CQ). However, due to the concern of QTc interval prolongation, the strict electrocardiogram monitoring was needed. The use of risk stratification score may help the decision of this monitoring.
 Aims: The study purpose is to describe the use of Tisdale risk score in patients with COVID-19 who received HCQ/CQ treatment.
 Methods: This was a prospective observational study. Subjects were patients with the diagnosis of high-probability-COVID-19 and confirmed-COVID-19 receiving HCQ/CQ as one of the treatments. The demographic, medical history and laboratory data were recorded. The Tisdale score was calculated based on baseline parameters and the risk categories were divided into three categories: low risk (score <7), moderate risk (score 7-10) and high risk (score ≥11). The HCQ/CQ daily dose, cumulative dose, time of administration, and duration were recorded.
 Result: Forty-five subjects were analysed. Most subjects were males (66.7%) at mean age 50.9 years. Most subjects were hospitalized due to severe illness (44.4%). Medical comorbidity was mostly hypertension (31.1%). Most subjects had HCQ treatment (95.6%). Electrocardiogram showed mostly sinus rhythm (97.8%). Mean QTc interval based Bazett formula was 413.1 ms. Tisdale risk categories were low risk (57.8%), moderate risk (31.1%) and high risk (11.1%). Tisdale high risk had significantly lower cumulative dose of HCQ/CQ and shorter duration of HCQ/CQ treatment as compared to Tisdale moderate and low risks counterparts. The premature HCQ/CQ stop occurred in 1 subject (6.7%) with Tisdale moderate risk and 1 subject (6.7%) with Tisdale high risk. 
 Conclusion: The Tisdale risk score stratification was easily implemented in hospital as a tool to guide in treatment decision and monitoring while dealing with drugs potentially cause QTc prolongation, such as HCQ/CQ, in COVID-19 patients.

Safety monitoring of chloroquine and hydroxychloroquine in COVID-19 patients in Indonesia on QT prolongation: hospital based monitoring study

“…26 The Tisdale risk score stratification was proposed in several referral hospitals in Indonesia as a tool to guide in treatment decision and monitoring while dealing with medications potentially cause QTc prolongation, such as CQ/HCQ, in COVID-19 patients due to the restriction of contact with patients and lack of dedicated electrocardiogram machine during pandemic. 27 In our study, out of 191 patients were assessed using Tisdale Score. Majority patients had low-risk score and only 7 (3.6%) patients had high-risk score.…”