title: 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 variceal bleeding.
  
  
  METHODS
  78 consecutive cirrhotic patients with acute variceal bleeding were included in the study. All patients were evaluated before bleeding (T0), during bleeding (T1) and 6 weeks later (T2).
  
  
  RESULTS
  HRS developed in 14 (17.9%) patients. QT corrected by heart rate (QTc) prolonged at T1, returning towards baseline at T2 (mean ± SD; from 424.0 ± 10.2 to 461.2 ± 17.6 to 426.1 ± 8.8ms, P < 0.001). At T1, patients who developed HRS had longer QTc (P = 0.017) and lower serum sodium (P = 0.039). QTc and serum sodium independently predicted HRS; the best cut-off values were QTc > 468 ms and sodium < 120 mEq/L. Patients on beta-blocker were found to have significant risk for developing HRS (p = 0.040). Based on these three factors, the risk for HRS was nil for patients without risk factors; 6.1%, 11.1%, and 83.3% for those with one, two or three risk factors, respectively (p < 0.001).
  
  
  CONCLUSIONS
  Acute variceal bleeding causes further prolongation of QTc in cirrhosis. The combination of beta-blocker, QTc interval and serum sodium can aid in early detection of patients at increased risk of developing bleed-precipitated HRS, thus improving their outcome.
authors.forename: George
authors.initials: G
authors.lastname: Peter
authors.forename: Paul Cheruvathoor
authors.initials: PC
authors.lastname: George
authors.forename: Mashhood Padincharepurathu
authors.initials: MP
authors.lastname: Villyoth
authors.forename: Sijil
authors.initials: S
authors.lastname: Sivaraman
authors.forename: Rooby Erachamveettil
authors.initials: RE
authors.lastname: Hamza
authors.forename: Suthanu
authors.initials: S
authors.lastname: Bahuleyan
authors.forename: Kadavanoor
authors.initials: K
authors.lastname: Srijith
authors.forename: Abhilash
authors.initials: A
authors.lastname: Haridas
authors.forename: Shanid
authors.initials: S
authors.lastname: Abdul Sathar
authors.forename: Srijaya
authors.initials: S
authors.lastname: Sreesh
authors.forename: Premalatha
authors.initials: P
authors.lastname: Narayanan
authors.forename: Kattoor Ramakrishnan
authors.initials: KR
authors.lastname: Vinayakumar
mesh_terms: D004562:Electrocardiography; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000503:physiopathology*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000503:physiopathology*; D006530:Hepatorenal Syndrome / Q000209:etiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors