VARİS KANAMASI OLAN SİROZ HASTALARINDA QTC İNTERVALİNİN DEĞERLENDİRİLMESİ

Abstract

Amaç: Bu çalışmada QTc intervalinin siroz hastalarında meydana gelen özofagus varis kanamasının mortalite ve morbidite üzerindeki etkisi araştırıldı. Gereç ve Yöntem: Çalışma, retrospektif, tek merkezli yapıldı. Hastaların kanama öncesi ve kanama anındaki QTc intervalleri hesaplandı. Hastaların demografik özellikleri ve mortalite durumları kaydedildi. Bulgular: Yüz elli altı hastanın 117'sinde kanama saptandı. Bunların %83'ü erkek, %17'si kadındı. Kanama anında ölçülen QTc intervali kanama öncesi ölçülenden uzundu (p<0,001). Kanama nedeniyle ölen hastaların QTc süresi 509,9 ms olarak bulundu. Erkekler için hesaplanan QTc değeri 520,6 ms ve kadınlar için hesaplanan 487,4 ms idi. Mortalite açısından QTc için yapılan ROC analizinde, erkeklerde 464,0 ms için sensitivite %82,4 ve spesivite %79,7 olarak bulundu (AUC:0,785; 95% CI 0.724-0,825). Kadınlarda QTc’nin 454,0 ms, cutoff değeri için sensitivite %77,8 ve spesivite %90,0 olarak bulundu (AUC:856; 95% CI 0.812-0,862). Sonuç: Siroz tanısı olan hastalarda özofagus varis kanaması durumunda QTc intervali uzamaktadır. Uzamış QTc intervali hastaların mortalite ve morbiditesi ile ilişkilidir.

Keywords

• Acil servis
• siroz
• QTc intervali
• varis kanaması

EVALUATION OF QTC INTERVAL IN CIRRHOSIS PATIENTS WITH VARICEAL HEMORRHAGE

Abstract

Objective: In this study, we investigated the effect of the QTc interval in cirrhosis patients on mortality and morbidity in esophageal variceal hemorrhages. Material and Method: It was retrospectively scanned in a single- centred design. The QTC intervals before and during the bleeding were calculated. The demographic characteristics and mortality status were recorded. Results: Bleeding was detected in 117 of the 156 patients. A total of 83% of these were male, and 17% were female. The QTc interval in these patients measured at the time of bleeding was longer than that measured before bleeding (p<0.001). The QTc interval of the patients who died due to bleeding was found to be 509.9 ms. It was calculated for males as 520.6 ms, and 487.4 ms for females. In the ROC analysis that was conducted for the QTc in terms of mortality, the sensitivity was 82.4% and specificity was 79.7% for 464.0 ms in males (AUC:0.785; 95% CI 0.724-0.825). The sensitivity was 77.8% and the specificity was 90.0% for QTc’s 454.0 ms cutoff value for females (AUC:856; 95% CI 0.812-0.862). Conclusion: The QTc interval is prolonged in the case of esophageal variceal hemorrhage in patients diagnosed with cirrhosis. A prolonged QTc interval is associated with mortality and morbidity of patients.

Keywords

• Emergency department
• cirrhosis
• QTc interval
• variceal hemorrhage

References

1. 1. Abbas A, Khan F, Rehman S, Ahsan O, Afzal A. Comparison of QTC interval prolongation in cirrhotic and non-cirrhotic chronic hepatitis c patients. Annals of Pims 2018;14(2):135-8.
2. 2. Bokarvadia R, Jain M, Kedarisetty C, Varghese J, Venkatarama J. prevalence and clinical presentation of cirrhotic cardiomyopathy: a single centre experience from Southern India. Indian Journal Of Gastroenterology 2019; 38(2):150-7. [CrossRef]
3. 3. Moss AJ. Measurement of the QT interval and the risk associated with QTC interval prolongation: A Review. Am J Cardid 1993;72:23-5. [CrossRef]
4. 4. Elming H, Brendorp B, Køber L, Sahebzadah N, Torp- Petersen C. QTc interval in the assessment of cardiac risk. Cardiac Electrophysiology Review 2002;6:289-94. [CrossRef]
5. 5. Ali M, Shahzad A, Adil IK, Alam S, Noor H, Imran A, Ganito N. Frequency of Corrected QT Interval in Patients With Cirrhosis. Journal of Rawalpindi Medical College (JRMC) 2016;20(2):79-81.
6. 6. Biselli M, Gramenzi A, Lenzi B, Dall’Agata M, Pierro ML, Perricone G, et al. Development and validation of a scoring system that includes corrected QT interval for risk analysis of patients with cirrhosis and gastrointestinal bleeding. Clinical Gastroenterology and Hepatology 2019;17:1388- 97. [CrossRef]
7. 7. Bambha K, Kim WR, Pedersen R, Bida JP, Kremers WK, Kamath PS. predictors of early re-bleeding and mortality after acute variceal haemorrhage in patients with cirrhosis. Gut 2008;57:814-20. [CrossRef]
8. 8. Trevisani F, Di Micoli A, Zambruni A, Biselli M, Santi V, Erroi V, et al. QT interval prolongation by acute gastrointestinal bleeding in patients with cirrhosis. Liver Int 2012;32(10):1510- 5. [CrossRef]

9. 9. Child CG, Turcotte JG. Surgery and Portal Hypertension. In: Child, C.G., Ed., The Liver and Portal Hypertension, Saunders, Philadelphia, 1964.P.50-64.
10. 10. Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973;60(8):646-9. [CrossRef]
11. 11. Bazett HC. An analysis of the time relations of electrocardiogram. Heart 1920;7:53-70. [CrossRef]
12. 12. Rautaharju PM, Surawicz B, Gettes LS, Bailey JJ, Childers R, Deal BJ, et al. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part IV: the ST segment, T and U waves, andthe QT interval: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology. J Am Coll Cardio 2009;53(11):982-91. [CrossRef]
13. 13. Peter G, George PC, Villyoth MP, Sivaraman S, Hamza RE, Srijith SBK, et al. QT interval prolongation: A risk factor for development of hepatorenal syndrome in cirrhotic patients with acute variceal bleeding. Tropical Gastroenterology 2014;35(3):157-63. [CrossRef]
14. 14. Kowalskı HJ, Abelmann WH. The cardiac output at rest in Laennec’s cirrhosis. J Clin Invest 1953;32(10):1025-33. [CrossRef]
15. 15. Figueiredo A, Bermejo FR, Perdigoto R, Marcelino P. The end-organ impairment in liver cirrhosis: appointments for critical care. Crit Care Res Pract 2012;2012:539412. [CrossRef]
16. 16. Pudila R, Peloucha R, Prausa R, Vasatovab M, Hulekc P. Heart failure in patients with liver cirrhosis. Cor et Vasa 2013;55(4):391-6. [CrossRef]
17. 17. Zambruni A, Trevisani F, Caraceni P, Bernardi M. Cardiac electrophysiological abnormalities in patients with cirrhosis. J Hepatol 2006;44(5):994-1002. [CrossRef]
18. 18. Zhao J, Qi X, Hou F, Ning Z, Zhang X. Deng H, et al. Prevalence, risk factors and in-hospital outcomes of qtc interval prolongation in liver cirrhosis. Am J Med Sci 2016;352(3):285-95.