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住院的慢性阻塞性肺疾病急性加重患者的长 QT 与死亡与电解质紊乱无关。

Long QT and death in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease is not related to electrolyte disorders.

机构信息

Internal Medicine Department A, Assaf-Harofeh Medical Center, Zerifin, Israel.

School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

出版信息

Int J Chron Obstruct Pulmon Dis. 2019 May 20;14:1053-1061. doi: 10.2147/COPD.S196428. eCollection 2019.

Abstract

COPD is the fourth-leading cause of mortality worldwide. Prolonged QTc has been found to be a long-term negative prognostic factor in ambulatory COPD patients. The aim of this study was to evaluate the extent of prolonged-QTc syndrome in COPD patients upon admission to an internal medicine department, its relationship to hypomagnesemia, hypokalemia, and hypocalcemia, and the effect of COPD treatment on mortality during hospital stay. This prospective cohort study evaluated COPD patients hospitalized in an internal medicine department. The study evaluated QTc, electrolyte levels, and known risk factors during hospitalization of COPD patients. A total of 67 patients were recruited. The median QTc interval was 0.441 seconds and 0.434 seconds on days 0 and 3, respectively. Prolonged QTc was noted in 35.8% of patients on admission and 37.3% on day 3 of hospitalization. The median QTc in the prolonged-QTc group on admission was 0.471 seconds and in the normal-QTc group 0.430 seconds. There was no significant difference in age, sex, electrolyte levels, renal function tests, or blood gases on admission between the two groups. Mortality during the hospital stay was significantly higher in the prolonged-QTc group (3 deaths, 12%) than in the normal QTc group (no deaths) (=0.04). A subanalysis was performed, removing known causes for prolonged QTc. We found no differences in age, electrolytes, or renal functions. There was a small but significant difference in bicarbonate levels. Our findings demonstrated that there was no correlation between QTc prolongation in hospitalized COPD patients and electrolyte levels, comorbidities, or relevant medications. A higher rate of mortality was noted in patients with prolonged QTc in comparison to normal QTc. As such, it is suggested that prolonged QTc could serve as a negative prognostic factor for mortality during hospitalization in COPD patients.

摘要

COPD 是全球第四大死亡原因。在门诊 COPD 患者中,长时间的 QTc 延长已被发现是一个长期的负面预后因素。本研究的目的是评估内科住院 COPD 患者中 QTc 延长综合征的程度、它与低镁血症、低钾血症和低钙血症的关系,以及 COPD 治疗对住院期间死亡率的影响。这项前瞻性队列研究评估了内科住院的 COPD 患者。研究评估了 QTc、电解质水平和 COPD 患者住院期间的已知危险因素。共招募了 67 名患者。入院时 QTc 间隔中位数为 0.441 秒,入院后第 3 天为 0.434 秒。入院时 35.8%的患者出现 QTc 延长,住院第 3 天为 37.3%。入院时 QTc 延长组的中位数为 0.471 秒,正常 QTc 组为 0.430 秒。两组患者入院时的年龄、性别、电解质水平、肾功能检查或血气无显著差异。在住院期间,延长 QTc 组的死亡率(3 例死亡,12%)明显高于正常 QTc 组(无死亡)(=0.04)。进行了亚分析,去除了导致 QTc 延长的已知原因。我们发现年龄、电解质或肾功能没有差异。碳酸氢盐水平略有但有显著差异。我们的研究结果表明,住院 COPD 患者的 QTc 延长与电解质水平、合并症或相关药物之间没有相关性。与正常 QTc 相比,延长 QTc 的患者死亡率更高。因此,建议延长 QTc 可作为 COPD 患者住院期间死亡率的负面预后因素。

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