Heart Rate-Corrected QT Interval Helps Predict Mortality after Intentional Organophosphate PoisoningReport as inadecuate




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Introduction

In this study, we investigated the outcomes for patients with intentional organophosphate poisoning. Previous reports indicate that in contrast to normal heart rate-corrected QT intervals QTc, QTc prolongation might be indicative of a poor prognosis for patients exposed to organophosphates.

Methods

We analyzed the records of 118 patients who were referred to Chang Gung Memorial Hospital for management of organophosphate poisoning between 2000 and 2011. Patients were grouped according to their initial QTc interval, i.e., normal <0.44 s or prolonged >0.44 s. Demographic, clinical, laboratory, and mortality data were obtained for analysis.

Results

The incidence of hypotension in patients with prolonged QTc intervals was higher than that in the patients with normal QTc intervals P = 0.019. By the end of the study, 18 of 118 15.2% patients had died, including 3 of 75 4.0% patients with normal QTc intervals and 15 of 43 34.9% patients with prolonged QTc intervals. Using multivariate-Cox-regression analysis, we found that hypotension OR = 10.930, 95% CI = 2.961–40.345, P = 0.000, respiratory failure OR = 4.867, 95% CI = 1.062–22.301, P = 0.042, coma OR = 3.482, 95% CI = 1.184–10.238, P = 0.023, and QTc prolongation OR = 7.459, 95% CI = 2.053–27.099, P = 0.002 were significant risk factors for mortality. Furthermore, it was revealed that non-survivors not only had longer QTc interval 503.00±41.56 versus 432.71±51.21 ms, P = 0.002, but also suffered higher incidences of hypotension 83.3 versus 12.0%, P = 0.000, shortness of breath 64 versus 94.4%, P = 0.010, bronchorrhea 55 versus 94.4%, P = 0.002, bronchospasm 50.0 versus 94.4%, P = 0.000, respiratory failure 94.4 versus 43.0%, P = 0.000 and coma 66.7 versus 11.0%, P = 0.000 than survivors. Finally, Kaplan-Meier analysis demonstrated that cumulative mortality was higher among patients with prolonged QTc intervals than among those with normal QTc intervals Log-rank test, Chi-square test = 20.36, P<0.001.

Conclusions

QTc interval helps predict mortality after intentional organophosphate poisoning.



Author: Shou-Hsuan Liu, Ja-Liang Lin, Cheng-Hao Weng, Huang-Yu Yang, Ching-Wei Hsu, Kuan-Hsing Chen, Wen-Hung Huang, Tzung-Hai Yen

Source: http://plos.srce.hr/



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