QT interval prolongation by acute gastrointestinal bleeding in patients with cirrhosis
Version of Record online: 10 JUL 2012
© 2012 John Wiley & Sons A/S
Volume 32, Issue 10, pages 1510–1515, November 2012
How to Cite
Trevisani, F., Di Micoli, A., Zambruni, A., Biselli, M., Santi, V., Erroi, V., Lenzi, B., Caraceni, P., Domenicali, M., Cavazza, M. and Bernardi, M. (2012), QT interval prolongation by acute gastrointestinal bleeding in patients with cirrhosis. Liver International, 32: 1510–1515. doi: 10.1111/j.1478-3231.2012.02847.x
- Issue online: 2 OCT 2012
- Version of Record online: 10 JUL 2012
- Manuscript Accepted: 5 JUN 2012
- Manuscript Received: 28 FEB 2012
- 6-week mortality;
- acute gastrointestinal bleeding;
- cirrhotic cardiomyopathy;
- MELD ;
- QT interval
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.
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).
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).
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.