BACKGROUND & AIMS: QT interval prolongation is frequent in cirrhosis, and stressful conditions could further prolong QT. We aimed to test this hypothesis and, if it proved correct, to assess its prognostic meaning. METHODS: We reviewed the clinical records of 70 consecutive cirrhotic and 40 non-cirrhotic patients with acute gastrointestinal bleeding. All patients had been evaluated before bleeding (T0) and were re-evaluated at the time of bleeding (T1) and 6 weeks afterwards (T2). RESULTS: QT corrected by heart rate (QTc) lengthened at T1, returning towards baseline values at T2 (mean ± SEM; from 415.9 ± 4.3 to 453.4 ± 4.3 to 422.2 ± 5.7 ms, P < 0.001) in cirrhotics; contrariwise, QTc did not change in non-cirrhotic patients. The 6-week mortality was 29.6% among cirrhotic patients, while no control patient died. At T1, patients who died had longer QTc (P = 0.001) and higher model of end-stage liver disease (MELD) score (P < 0.001) than survivors. MELD and QTc independently predicted survival. Their areas under the ROC curve were 0.88 (CI 95% 0.78-0.95) and 0.75 (CI 95% 0.63-0.85) respectively; the best cut-off values were MELD ≥20 and QTc ≥ 460 ms. Based on these factors, the 6-week mortality was: 0% for patients without risk factors, 32.1% for those with one risk factor and 70.6% for those with both (P < 0.001). CONCLUSIONS: Acute gastrointestinal bleeding further prolongs QTc in cirrhosis. This abnormality independently predicts bleeding-induced mortality. The combined measurement of QTc interval and MELD can clearly identify three patient strata at increasing risk of bleeding-related mortality, thus improving the decision-making for these patients.

QT interval prolongation by acute gastrointestinal bleeding in patients with cirrhosis / Trevisani F; Di Micoli A; Zambruni A; Biselli M; Santi V; Erroi V; Lenzi B; Caraceni P; Domenicali M; Cavazza M; Bernardi M.. - In: LIVER INTERNATIONAL. - ISSN 1478-3223. - STAMPA. - 32:(2012), pp. 1510-1515. [10.1111/j.1478-3231.2012.02847.x.]

QT interval prolongation by acute gastrointestinal bleeding in patients with cirrhosis.

TREVISANI, FRANCO;DI MICOLI, ANTONIO;ZAMBRUNI, ANDREA;BISELLI, MAURIZIO;LENZI, BARBARA;CARACENI, PAOLO;DOMENICALI, MARCO;BERNARDI, MAURO
2012

Abstract

BACKGROUND & AIMS: QT interval prolongation is frequent in cirrhosis, and stressful conditions could further prolong QT. We aimed to test this hypothesis and, if it proved correct, to assess its prognostic meaning. METHODS: We reviewed the clinical records of 70 consecutive cirrhotic and 40 non-cirrhotic patients with acute gastrointestinal bleeding. All patients had been evaluated before bleeding (T0) and were re-evaluated at the time of bleeding (T1) and 6 weeks afterwards (T2). RESULTS: QT corrected by heart rate (QTc) lengthened at T1, returning towards baseline values at T2 (mean ± SEM; from 415.9 ± 4.3 to 453.4 ± 4.3 to 422.2 ± 5.7 ms, P < 0.001) in cirrhotics; contrariwise, QTc did not change in non-cirrhotic patients. The 6-week mortality was 29.6% among cirrhotic patients, while no control patient died. At T1, patients who died had longer QTc (P = 0.001) and higher model of end-stage liver disease (MELD) score (P < 0.001) than survivors. MELD and QTc independently predicted survival. Their areas under the ROC curve were 0.88 (CI 95% 0.78-0.95) and 0.75 (CI 95% 0.63-0.85) respectively; the best cut-off values were MELD ≥20 and QTc ≥ 460 ms. Based on these factors, the 6-week mortality was: 0% for patients without risk factors, 32.1% for those with one risk factor and 70.6% for those with both (P < 0.001). CONCLUSIONS: Acute gastrointestinal bleeding further prolongs QTc in cirrhosis. This abnormality independently predicts bleeding-induced mortality. The combined measurement of QTc interval and MELD can clearly identify three patient strata at increasing risk of bleeding-related mortality, thus improving the decision-making for these patients.
2012
QT interval prolongation by acute gastrointestinal bleeding in patients with cirrhosis / Trevisani F; Di Micoli A; Zambruni A; Biselli M; Santi V; Erroi V; Lenzi B; Caraceni P; Domenicali M; Cavazza M; Bernardi M.. - In: LIVER INTERNATIONAL. - ISSN 1478-3223. - STAMPA. - 32:(2012), pp. 1510-1515. [10.1111/j.1478-3231.2012.02847.x.]
Trevisani F; Di Micoli A; Zambruni A; Biselli M; Santi V; Erroi V; Lenzi B; Caraceni P; Domenicali M; Cavazza M; Bernardi M.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/133016
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