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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
QT prolongation is associated with increased mortality in end stage liver disease
Sun Moon Kim, Bennet George, Diego Alcivar-Franco, Charles L Campbell, Richard Charnigo, Brian Delisle, Jonathan Hundley, Yousef Darrat, Gustavo Morales, Samy-Claude Elayi, Alison L Bailey
Sun Moon Kim, Bennet George, Brian Delisle, Yousef Darrat, Gustavo Morales, Samy-Claude Elayi, Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY 40509, United States
Diego Alcivar-Franco, Department of Cardiology, Summa Health System, Akron, OH 44304, United States
Charles L Campbell, Alison L Bailey, Division of Cardiovascular Medicine, Erlanger Health System, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN 37403, United States
Richard Charnigo, Departments of Biostatistics and Statistics, University of Kentucky, Lexington, KY 40536, United States
Jonathan Hundley, Piedmont Transplant Institute, Atlanta, GA 30309, United States
Author contributions: Kim SM designed and performed the research and wrote the paper; Bailey AL and Elayi SC designed the research and supervised the report; George B, Alcivar-Franco D and Charnigo R contributed to the analysis; Campbell CL, Delisle B, Hundley J, Darrat Y and Morales G provided clinical advice.
Institutional review board statement: This study was reviewed and approved by the institutional review board at University of Kentucky.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used clinical data without storage of patient identifiers that were obtained after each patient agreed to treatment by written consent. Waiver of informed consent was also obtained because the research involved no more than minimal risk and met criteria specified by federal regulations.
Conflict-of-interest statement: The authors of this manuscript have no conflict of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Samy-Claude Elayi, MD, Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, 900 South Limestone, Room 326 Wethington Bldg, Lexington, KY 40509, United States.
samy-claude.elayi@uky.edu
Telephone: +1-859-3238040 Fax: +1-859-3236475
Received: November 16, 2016
Peer-review started: November 18, 2016
First decision: November 30, 2016
Revised: January 13, 2017
Accepted: February 18, 2017
Article in press: February 20, 2017
Published online: April 26, 2017
Processing time: 173 Days and 7.3 Hours
AIM
To determine the prevalence of QT prolongation in a large series of end stage liver disease (ESLD) patients and its association to clinical variables and mortality.
METHODS
The QT interval was measured and corrected for heart rate for each patient, with a prolonged QT cutoff defined as QT > 450 ms for males and QT > 470 ms for females. Multiple clinical variables were evaluated including sex, age, serum sodium, international normalized ratio, creatinine, total bilirubin, beta-blocker use, Model for End-Stage Liver Disease (MELD), MELD-Na, and etiology of liver disease.
RESULTS
Among 406 ESLD patients analyzed, 207 (51.0%) had QT prolongation. The only clinical variable associated with QT prolongation was male gender (OR = 3.04, 95%CI: 2.01-4.60, P < 0.001). During the study period, 187 patients (46.1%) died. QT prolongation was a significant independent predictor of mortality (OR = 1.69, 95%CI: 1.03-2.77, P = 0.039). In addition, mortality was also associated with viral etiology of ESLD, elevated MELD score and its components (P < 0.05 for all). No significant reversibility in the QT interval was seen after liver transplantation.
CONCLUSION
QT prolongation was commonly encountered in an ESLD population, especially in males, and served as a strong independent marker for increased mortality in ESLD patients.
Core tip: We performed a case-control retrospective study in a large cohort of patients with end stage liver disease (ESLD) to determine the prevalence of QT prolongation and its association to clinical variables and mortality. Our results showed a high prevalence of QT prolongation in ESLD patients (51%), especially in males, and QT prolongation was a significant independent predictor of mortality. Based on our findings, we recommend close monitoring of the QT interval in ESLD patients with increased attention to any modifiable causes for QT prolongation.
