QT interval prolongation: a risk factor for development of hepatorenal syndrome in cirrhotic patients with acute variceal bleeding

Peter, George; Pc, George; Mp, Villyoth; Sivaraman, Subash; Re, Hamza; Bahuleyan, Suthanu; K, Srijith; Haridas, Arun Kumar; S, Abdul Sathar; Sreesh, Srijaya; Narayanan, Pradeep; Kr, Vinayakumar

doi:10.7869/tg.203

Cited by 3 publications

(2 citation statements)

References 29 publications

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“…They also noted that the difference between these two values was an independent risk factor in predicting Hepatorenal syndrome. In this respect, they argued that QTc was a good tool in predicting the severity of cirrhosis and the risk of bleeding (13).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of QTC Interval in Cirrhosis Patients With Variceal Hemorrhage

Karaali¹,

Payza²,

KAYALI³

et al. 2021

J Istanb Fac Med

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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.

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Section: Discussionmentioning

confidence: 99%

Evaluation of QTC Interval in Cirrhosis Patients With Variceal Hemorrhage

Karaali¹,

Payza²,

KAYALI³

et al. 2021

J Istanb Fac Med

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“…However, these interesting results must be confirmed by larger prospective observational studies, because this association may merely reflect that QT intervals generally correlate with degree of liver dysfunction, ie, more advanced cirrhosis shows greater prolongation of QTc. Peter and colleagues demonstrated that QTc, serum Na + concentration and β-blocker use predicted development of hepatorenal syndrome in 78 consecutive patients admitted with variceal bleeding 32 . However, as there were only 14 cases of hepatorenal syndrome (HRS), this small study needs to be confirmed by larger trials.…”

Section: Nsbb Decrease Electrocardiographic Qt Intervalsmentioning

confidence: 99%

β-blockers in advanced cirrhosis: More friend than enemy

2021

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Nonselective beta-adrenergic blocker (NSBB) therapy for the prevention of initial and recurrent gastrointestinal bleeding in cirrhotic patients with gastroesophageal varices has been used for the past four decades. NSBB therapy is considered the cornerstone of treatment for varices, and has become the standard of care. However, a 2010 study from the group that pioneered β-blocker therapy suggested a detrimental effect of NSBBs in decompensated cirrhosis, especially in patients with refractory ascites. Since then, numerous additional studies have incompletely resolved whether NSBBs are deleterious, although more recent evidence weighs against a harmful effect. The possibility of a “therapeutic window” has also been raised. We aimed to review the literature to analyze the pros and cons of using NSBBs in patients with cirrhosis, not only with respect to bleeding or mortality but also to other potential benefits and risks. β-blockers are highly effective in preventing first bleeding and recurrent bleeding. Furthermore, NSBBs improve congestion/ischemia of the gut mucosa, decrease intestinal permeability, and therefore indirectly alleviate systemic inflammation. β-blockers shorten the electrocardiographic prolonged QTc interval and may also decrease the incidence of hepatocellular carcinoma. On the other hand, the possibility of deleterious effects in cirrhosis has not been completely eliminated. NSBBs may be associated with an increased risk of portal vein thrombosis, although this could be correlational artifact. Overall, we conclude that β-blockers in cirrhosis are much more of a friend than enemy.

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Corrected QT interval in cirrhosis: A systematic review and meta-analysis

Papadopoulos,

Mimidis

2023

World J Hepatol

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Surrogate endpoints are needed to estimate clinical outcomes in primary sclerosing cholangitis (PSC). Serum alkaline phosphatase was among the first markers studied, but there is substantial variability in alkaline phosphatase levels during the natural history of PSC without intervention. The Mayo risk score incorporates noninvasive variables and has served as a surrogate endpoint for survival for more than two decades. Newer models have better test performance than the Mayo risk score, including the primary sclerosing risk estimate tool (PREsTo) model and UK-PSC score that estimate hepatic decompensation and transplant free survival, respectively. The c-statistics for transplant-free survival for the Mayo risk model and the long-term UK-PSC model are 0.68 and 0.85, respectively. The c-statistics for hepatic decompensation for the Mayo risk model and PREsTo model are 0.85 and 0.90, respectively. The Amsterdam-Oxford model included patients with large duct and small duct PSC and patients with PSC-autoimmune hepatitis overlap and had a c-statistic of 0.68 for transplant-free survival. Other noninvasive tests that warrant further validation include magnetic resonance imaging, elastography and the enhanced liver fibrosis score. Prognostic models, noninvasive tests or a combination of these surrogate endpoints may not only serve to be useful in clinical trials of investigational agents, but also serve to inform our patients about their prognosis.

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QT interval prolongation: a risk factor for development of hepatorenal syndrome in cirrhotic patients with acute variceal bleeding

Abstract: Background: This study aimed to assess whether QT interval prolongation is an independent risk factor for development of hepatorenal syndrome (HRS) in cirrhotic patients with acute

Cited by 3 publications

References 29 publications

Evaluation of QTC Interval in Cirrhosis Patients With Variceal Hemorrhage

Evaluation of QTC Interval in Cirrhosis Patients With Variceal Hemorrhage

β-blockers in advanced cirrhosis: More friend than enemy

Corrected QT interval in cirrhosis: A systematic review and meta-analysis

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