Lin Yajuan, Yu Haixu, Liu Fei, Chen Cheng, Zhang Yanli, Wang Binhao, Yang Yiheng, Liu Ying, Zhang Li, Xia Yunlong
1Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Zhongshan Road 222, PO Box 116011, Dalian, Liaoning China.
2Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China.
Cardiooncology. 2020 Feb 14;6:3. doi: 10.1186/s40959-020-0057-2. eCollection 2020.
Our recent study has revealed that many hospitalized patients with acquired long QT syndrome (ALQTS) are cancer patients. This study aims to determine the risk factors and outcomes of hospitalized cancer patients with ALQTS.
We performed a matched case-control study within a cohort of 10,180 cancer patients hospitalized between September 2013 and April 2016. Among them, 150 patients defined as having severe ALQTS with a markedly prolonged QT interval (QTc ≥ 500 ms) were compared with 293 age-, sex- and cancer-type-matched controls (non-ALQTS). Death as the endpoint was followed for up to 2 years. Cox regression and Kaplan-Meier survival analyses were performed to assess the effects of particular clinical variables on all-cause mortality. Multivariate logistic regression was performed to calculate odds ratios (OR) for various predictors of QT prolongation.
The mortality was significantly higher in ALQTS group (63.3% vs. 33.4%). Hypertension, hypokalemia, hypocalcemia, QT-prolonging drugs, infection, anemia, anti-microtubule agents were contributing factors to ALQTS. Renal insufficiency, male gender and hypokalemia were found to be independent risk factors for all-cause mortality in ALQTS group.
Markedly prolonged QT interval was seen in 1.5% of hospitalized cancer patients. The all-cause mortality was high in cancer patients with severe ALQTS.
我们最近的研究表明，许多获得性长QT综合征（ALQTS）住院患者是癌症患者。本研究旨在确定住院癌症合并ALQTS患者的危险因素及预后情况。
我们在2013年9月至2016年4月期间住院的10180例癌症患者队列中进行了一项匹配病例对照研究。其中，150例被定义为患有严重ALQTS且QT间期显著延长（QTc≥500毫秒）的患者与293例年龄、性别和癌症类型匹配的对照者（非ALQTS）进行比较。以死亡为终点，随访长达2年。采用Cox回归和Kaplan-Meier生存分析来评估特定临床变量对全因死亡率的影响。进行多因素逻辑回归分析以计算QT延长各种预测因素的比值比（OR）。
ALQTS组的死亡率显著更高（63.3%对33.4%）。高血压、低钾血症、低钙血症、延长QT的药物、感染、贫血、抗微管药物是导致ALQTS的因素。肾功能不全、男性和低钾血症被发现是ALQTS组全因死亡率的独立危险因素。
1.5%的住院癌症患者出现QT间期显著延长。严重ALQTS的癌症患者全因死亡率很高。
