Dataset Information

Characteristics, predictors and outcomes of new-onset QT prolongation in sepsis: a multicenter retrospective study.

ABSTRACT:

Background

Sepsis-induced myocardial injury is a serious complication of sepsis. QT prolongation is a proarrhythmic state which reflects myocardial injury in a group of heterogeneous disorders. However, the study on the clinical value of QT prolongation in sepsis is limited.

Methods

We aimed to investigate the clinical characteristics and predictors of new-onset QT prolongation in sepsis and its impact on the outcome in a multicenter retrospective cohort study. Electrocardiographic and clinical data were collected from patients with sepsis from the wards and intensive care units of four centers after exclusion of QT-influencing medications and electrolyte abnormalities. Clinical outcomes were compared between patients with and without QT prolongation (QTc > 450 ms). Multivariate analysis was performed to ascertain whether QT prolongation was an independent predictor for 30-day mortality. The factors predicting QT prolongation in sepsis were also analyzed.

Results

New-onset QT prolongation occurred in 235/1024 (22.9%) patients. The majority demonstrated similar pattern as type 1 long QT syndrome. Patients with QT prolongation had a higher 30-day in-hospital mortality (P < 0.001), which was also associated with increased tachyarrhythmias including paroxysmal atrial fibrillation or tachycardia (P < 0.001) and ventricular arrhythmia (P < 0.001) during hospitalization. QT prolongation independently predicted 30-day mortality (P = 0.044) after multivariate analysis. History of coronary artery disease (P = 0.001), septic shock (P = 0.008), acute respiratory (P < 0.001), heart (P = 0.021) and renal dysfunction (P = 0.013) were independent predictors of QT prolongation in sepsis.

Conclusions

New-onset QT prolongation in sepsis was associated with increased mortality as well as atrial and ventricular arrhythmias, which was predicted by disease severity and organ dysfunction.

SUBMITTER: Liu W

PROVIDER: S-EPMC11003155 | biostudies-literature | 2024 Apr

REPOSITORIES: biostudies-literature

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Publications

Characteristics, predictors and outcomes of new-onset QT prolongation in sepsis: a multicenter retrospective study.

Liu Weizhuo W Shao Rongjiao R Zhang Shen S Jin Lei L Liu Rongchen R Chen Peidong P Hu Jintao J Ma Haocheng H Wu Bangwei B Liang Weiguo W Luo Xinping X Li Jian J Chen Weiming W Xiong Nanqing N He Bin B

Critical care (London, England) 20240409 1

<h4>Background</h4>Sepsis-induced myocardial injury is a serious complication of sepsis. QT prolongation is a proarrhythmic state which reflects myocardial injury in a group of heterogeneous disorders. However, the study on the clinical value of QT prolongation in sepsis is limited.<h4>Methods</h4>We aimed to investigate the clinical characteristics and predictors of new-onset QT prolongation in sepsis and its impact on the outcome in a multicenter retrospective cohort study. Electrocardiographi ...[more]

PMID: 38594724

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Project description:BackgroundSepsis is the leading cause of in-hospital death. The SEP-1 sepsis bundle is a protocol for early sepsis care that requires providers to diagnose and treat sepsis quickly. Limited evidence suggests that adherence to the sepsis bundle is lower in cases of hospital-onset sepsis.ObjectiveTo compare sepsis bundle adherence in hospital-onset vs. community-onset sepsis.DesignRetrospective cohort study using multivariable analysis of clinical data.ParticipantsA total of 4658 inpatients age 18 or older were identified by diagnosis codes consistent with sepsis or disseminated infection.SettingFour university hospitals in California between 2014 and 2016.Main outcomes and measuresThe primary outcome was adherence to key components of the sepsis bundle defined by the Centers for Medicare and Medicaid Services in their core measure, SEP-1. Covariates included clinical characteristics related to the patient, infection, and pathogen.Key resultsCompared with community-onset, cases of hospital-onset sepsis were less likely to receive SEP-1 adherent care (relative risk 0.33, 95% confidence interval 0.29-0.38, p < 0.001). With the exception of vasopressors (RR 1.11, p = 0.002), each component of SEP-1 evaluated-blood cultures (RR 0.76, p < 0.001), serum lactate (RR 0.51, p < 0001), broad-spectrum antibiotics (RR 0.62, p < 0.001), intravenous fluids (0.47, p < 0.001), and follow-up lactate (RR 0.71, p < 0.001)-was less likely to be performed within the recommended time frame in hospital-onset sepsis. Within the hospital, cases of hospital-onset sepsis arising on the ward were less likely to receive SEP-1-adherent care than were cases arising in the intensive care unit (RR 0.68, p = 0.004).ConclusionsInpatients with hospital-onset sepsis receive different management than individuals with community-onset sepsis. It remains to be determined whether system-level factors, provider-level factors, or factors related to measurement explain the observed variation in care or whether variation in care affects outcomes.

Dataset Information

Characteristics, predictors and outcomes of new-onset QT prolongation in sepsis: a multicenter retrospective study.

Background

Methods

Results

Conclusions

Publications

Characteristics, predictors and outcomes of new-onset QT prolongation in sepsis: a multicenter retrospective study.

Similar Datasets

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