Development and validation of a risk score to predict QT interval prolongation in hospitalized patients

James E. Tisdale, Heather A. Jaynes, Joanna R. Kingery, Noha A. Mourad, Tate N. Trujillo, Brian R. Overholser, Richard J. Kovacs

Research output: Contribution to journalArticle

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Abstract

Background-Identifying hospitalized patients at risk for QT interval prolongation could lead to interventions to reduce the risk of torsades de pointes. Our objective was to develop and validate a risk score for QT prolongation in hospitalized patients. Methods and Results-In this study, in a single tertiary care institution, consecutive patients (n=900) admitted to cardiac care units comprised the risk score development group. The score was then applied to 300 additional patients in a validation group. Corrected QT (QTc) interval prolongation (defined as QTc>500 ms or an increase of >60 ms from baseline) occurred in 274 (30.4%) and 90 (30.0%) patients in the development group and validation group, respectively. Independent predictors of QTc prolongation included the following: female (odds ratio, 1.5; 95% confidence interval, 1.1-2.0), diagnosis of myocardial infarction (2.4 [1.6-3.9]), septic shock (2.7 [1.5-4.8]), left ventricular dysfunction (2.7 [1.6-5.0]), administration of a QT-prolonging drug (2.8 [2.0-4.0]), ≥2 QT-prolonging drugs (2.6 [1.9-5.6]), or loop diuretic (1.4 [1.0-2.0]), age >68 years (1.3 [1.0-1.9]), serum K+ <3.5 mEq/L (2.1 [1.5-2.9]), and admitting QTc >450 ms (2.3; confidence interval [1.6-3.2]). Risk scores were developed by assigning points based on log odds ratios. Low-, moderate-, and high-risk ranges of 0 to 6, 7 to 10, and 11 to 21 points, respectively, best predicted QTc prolongation (C statistic=0.823). A high-risk score ≥11 was associated with sensitivity=0.74, specificity=0.77, positive predictive value=0.79, and negative predictive value=0.76. In the validation group, the incidences of QTc prolongation were 15% (low risk); 37% (moderate risk); and 73% (high risk). Conclusions-A risk score using easily obtainable clinical variables predicts patients at highest risk for QTc interval prolongation and may be useful in guiding monitoring and treatment decisions.

Original languageEnglish (US)
Pages (from-to)479-487
Number of pages9
JournalCirculation: Cardiovascular Quality and Outcomes
Volume6
Issue number4
DOIs
StatePublished - Jul 1 2013

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Odds Ratio
Confidence Intervals
Sodium Potassium Chloride Symporter Inhibitors
Torsades de Pointes
Left Ventricular Dysfunction
Tertiary Healthcare
Septic Shock
Pharmaceutical Preparations
Myocardial Infarction
Sensitivity and Specificity
Incidence
Serum
Therapeutics

Keywords

  • Electrocardiography
  • Predictors
  • QT interval
  • Risk factors
  • Torsades de pointes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Development and validation of a risk score to predict QT interval prolongation in hospitalized patients. / Tisdale, James E.; Jaynes, Heather A.; Kingery, Joanna R.; Mourad, Noha A.; Trujillo, Tate N.; Overholser, Brian R.; Kovacs, Richard J.

In: Circulation: Cardiovascular Quality and Outcomes, Vol. 6, No. 4, 01.07.2013, p. 479-487.

Research output: Contribution to journalArticle

Tisdale, James E. ; Jaynes, Heather A. ; Kingery, Joanna R. ; Mourad, Noha A. ; Trujillo, Tate N. ; Overholser, Brian R. ; Kovacs, Richard J. / Development and validation of a risk score to predict QT interval prolongation in hospitalized patients. In: Circulation: Cardiovascular Quality and Outcomes. 2013 ; Vol. 6, No. 4. pp. 479-487.
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AU - Jaynes, Heather A.

AU - Kingery, Joanna R.

AU - Mourad, Noha A.

AU - Trujillo, Tate N.

AU - Overholser, Brian R.

AU - Kovacs, Richard J.

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N2 - Background-Identifying hospitalized patients at risk for QT interval prolongation could lead to interventions to reduce the risk of torsades de pointes. Our objective was to develop and validate a risk score for QT prolongation in hospitalized patients. Methods and Results-In this study, in a single tertiary care institution, consecutive patients (n=900) admitted to cardiac care units comprised the risk score development group. The score was then applied to 300 additional patients in a validation group. Corrected QT (QTc) interval prolongation (defined as QTc>500 ms or an increase of >60 ms from baseline) occurred in 274 (30.4%) and 90 (30.0%) patients in the development group and validation group, respectively. Independent predictors of QTc prolongation included the following: female (odds ratio, 1.5; 95% confidence interval, 1.1-2.0), diagnosis of myocardial infarction (2.4 [1.6-3.9]), septic shock (2.7 [1.5-4.8]), left ventricular dysfunction (2.7 [1.6-5.0]), administration of a QT-prolonging drug (2.8 [2.0-4.0]), ≥2 QT-prolonging drugs (2.6 [1.9-5.6]), or loop diuretic (1.4 [1.0-2.0]), age >68 years (1.3 [1.0-1.9]), serum K+ <3.5 mEq/L (2.1 [1.5-2.9]), and admitting QTc >450 ms (2.3; confidence interval [1.6-3.2]). Risk scores were developed by assigning points based on log odds ratios. Low-, moderate-, and high-risk ranges of 0 to 6, 7 to 10, and 11 to 21 points, respectively, best predicted QTc prolongation (C statistic=0.823). A high-risk score ≥11 was associated with sensitivity=0.74, specificity=0.77, positive predictive value=0.79, and negative predictive value=0.76. In the validation group, the incidences of QTc prolongation were 15% (low risk); 37% (moderate risk); and 73% (high risk). Conclusions-A risk score using easily obtainable clinical variables predicts patients at highest risk for QTc interval prolongation and may be useful in guiding monitoring and treatment decisions.

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