title: High prevalence of corrected QT interval prolongation in acutely ill patients is associated with mortality: results of the QT in Practice (QTIP) Study.
abstract: OBJECTIVE
  To test the potential value of more frequent QT interval measurement in hospitalized patients.
  
  
  METHODS
  We performed a prospective, observational study.
  
  
  METHODS
  All adult intensive care unit and progressive care unit beds of a university medical center.
  
  
  METHODS
  All patients admitted to one of six critical care units over a 2-month period were included in analyses.
  
  
  METHODS
  All critical care beds (n = 154) were upgraded to a continuous QT monitoring system (Philips Healthcare).
  
  
  RESULTS
  QT data were extracted from the bedside monitors for offline analysis. A corrected QT interval >500 msecs was considered prolonged. Episodes of QT prolongation were manually over-read. Electrocardiogram data (67,648 hrs, mean 65 hrs/patient) were obtained. QT prolongation was present in 24%. There were 16 cardiac arrests, with one resulting from Torsade de Pointes (6%). Predictors of QT prolongation were female sex, QT-prolonging drugs, hypokalemia, hypocalcemia, hyperglycemia, high creatinine, history of stroke, and hypothyroidism. Patients with QT prolongation had longer hospitalization (276 hrs vs. 132 hrs, p < .0005) and had three times the odds for all-cause in-hospital mortality compared to patients without QT prolongation (odds ratio 2.99 95% confidence interval 1.1-8.1).
  
  
  CONCLUSIONS
  We find QT prolongation to be common (24%), with Torsade de Pointes representing 6% of in-hospital cardiac arrests. Predictors of QT prolongation in the acutely ill population are similar to those previously identified in ambulatory populations. Acutely ill patients with QT prolongation have longer lengths of hospitalization and nearly three times the odds for mortality then those without QT prolongation.
authors: Department of Physiological Nursing, University of California San Francisco, San Francisco, CA, USA. david.pickham@ucsf.edu
authors: David
authors: D
authors: Pickham
authors: Eric
authors: E
authors: Helfenbein
authors: Julie A
authors: JA
authors: Shinn
authors: Garrett
authors: G
authors: Chan
authors: Marjorie
authors: M
authors: Funk
authors: Ann
authors: A
authors: Weinacker
authors: Jia-Ni
authors: JN
authors: Liu
authors: Barbara J
authors: BJ
authors: Drew
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006323:Heart Arrest / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008133:Long QT Syndrome / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D016017:Odds Ratio; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016171:Torsades de Pointes / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy