Clinical Investigation
Prevalence, Risk Factors and In-hospital Outcomes of QTc Interval Prolongation in Liver Cirrhosis,☆☆,☆☆☆

https://doi.org/10.1016/j.amjms.2016.06.012Get rights and content

Abstract

Background

QTc interval prolongation is an electrocardiographic abnormality in liver cirrhosis. The objective of this study was to evaluate the prevalence, risk factors and in-hospital outcomes of QTc interval prolongation in Chinese patients with liver cirrhosis.

Methods

This was a retrospective analysis of a total of 1,268 patients with liver cirrhosis who were consecutively admitted to our hospital between January 2011 and June 2014. QTc interval data were collected from the medical records. QTc interval prolongation was defined as QTc interval > 440 milliseconds.

Results

The prevalence of QTc interval prolongation was 38.2% (485 of 1268). In the entire cohort, the risk factors for QTc interval prolongation included an older age, a higher proportion of alcohol abuse and ascites, higher bilirubin, blood urea nitrogen, creatinine, prothrombin time, international normalized ratio, Child-Pugh score and model for end-stage liver diseases score, and lower red blood cell (RBC), hemoglobin (Hb), albumin (ALB), alanine aminotransferase and calcium. The in-hospital mortality was not significantly different between patients with and without QTc interval prolongation (2.1% versus 1.3%, P = 0.276). In the subgroup analyses of patients with hepatitis B virus or alcohol alone–related liver cirrhosis, the risk factors included higher bilirubin, creatinine, prothrombin time, international normalized ratio, Child-Pugh score and model for end-stage liver diseases score, and lower RBC, Hb and ALB. In the subgroups analyses of patients with acute upper gastrointestinal bleeding or ascites, the risk factors included lower RBC, Hb and ALB.

Conclusions

QTc interval prolongation was frequent in liver cirrhosis. Although QTc interval prolongation was positively associated with alcohol-related liver cirrhosis and more severe liver dysfunction, it did not significantly influence the in-hospital mortality.

Introduction

Currently, the knowledge of cirrhotic cardiomyopathy is gradually improving.1, 2, 3, 4, 5, 6, 7 Cirrhotic cardiomyopathy is defined as an impaired systolic response to physical stress, diastolic dysfunction and cardiac electrophysiological abnormalities. The abnormalities of cardiac electrophysiology in liver cirrhosis mainly include chronotropic incompetence, electromechanical uncoupling, increased QT dispersion and electrocardiographic QTc interval prolongation.8 The presence of QTc interval prolongation is the most widely recognized abnormality in liver cirrhosis. However, the relevant data were almost all from Western countries. To the best of our knowledge, few studies have evaluated the prevalence of QTc interval prolongation in Chinese patients with liver cirrhosis. Considering the difference in the patients’ races and etiology of liver cirrhosis between Western countries and China, further studies should focus on Chinese patients. On the contrary, although QTc interval prolongation predicts the risk of serious arrhythmias and sudden death, its relationship with in-hospital mortality in liver cirrhosis remains unclear. Herein, we performed a retrospective observational study to evaluate the prevalence, risk factors and in-hospital outcomes of QTc interval prolongation in a large group of Chinese patients with liver cirrhosis.

Section snippets

Methods

We selected all patients with a diagnosis of liver cirrhosis who were consecutively admitted to the General Hospital of Shenyang Military Area between January 2011 and June 2014. Malignancy was excluded. Repeated admissions were not excluded. Patients with liver cirrhosis were identified by the international classification codes 9 and 10 and by the clinical diagnosis reported by medical records in the Department of Information. All eligible patients should have undergone the 12-lead

Results

Overall, 1,268 patients with liver cirrhosis who had QTc interval data were enrolled in the study (Table 1). The most common causes of liver cirrhosis were hepatitis B virus (HBV) alone (357 of 1,265; 28.2%) and alcohol alone (321 of 1,265; 25.4%). Of them, 42.7%, 45.3% and 12% had Child-Pugh class A, B and C, respectively. The prevalence of QTc interval prolongation was 38.2% (485 of 1,268). The in-hospital mortality rate was 1.6%.

Discussion

This was a large retrospective observational study which aimed to evaluate the prevalence, risk factors and in-hospital mortality of QTc interval prolongation in liver cirrhosis. Our study found that QTc interval prolongation was common in patients with liver cirrhosis, but it was not significantly associated with in-hospital mortality. The severity of liver dysfunction might be associated with the presence of QTc interval prolongation. Based on the results of subgroup analyses, ALB appeared to

Conclusions

A prolonged QTc interval was frequently observed in patients with liver cirrhosis. QTc interval prolongation was positively associated with alcohol-related liver cirrhosis and more severe liver dysfunction. However, it did not significantly influence the in-hospital mortality of cirrhotic patients. Further well-designed, large sample size, long-term follow-up prospective studies, in which all cirrhotic patients should be consecutively included and patients with a recent history of diseases and

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  • Cited by (0)

    The first two authors (JZ, XQ) contributed equally to this work.

    ☆☆

    The following authors (XQ, XG) were joint senior authors.

    ☆☆☆

    The authors have no financial or other conflicts of interest to disclose.

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