Hospital Pharmacy, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany.
Doctoral Program Clinical Pharmacy, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany.
Int J Clin Pharm. 2024 Dec;46(6):1436-1444. doi: 10.1007/s11096-024-01788-w. Epub 2024 Aug 14.
QTc interval prolongation can result in potentially lethal arrhythmias. One risk factor is QTc-prolonging drugs, including some antifungals often used in hemato-oncology patients. Screening tools for patients at risk have not yet been investigated in this patient population.
Our aim was to evaluate the sensitivity and specificity of five QTc risk scores in hemato-oncology patients receiving systemic antifungal therapy.
Data were retrieved from an internal study database including adult hemato-oncology patients prescribed systemic antifungal therapy. Data on QTc-prolonging medication, risk factors for QTc prolongation, and electrocardiograms (ECG) were collected retrospectively for a period of 12 months. The QTc risk scores according to Tisdale, Vandael, Berger, Bindraban, and Aboujaoude as well as their sensitivity and specificity were calculated.
During the evaluated period, 77 patients were prescribed systemic antifungals resulting in 187 therapy episodes. Regarding therapy episodes, median age was 56 years (IQR 44-68), 41% (77) were female, and a median of 3 QTc-prolonging drugs were prescribed (range 0-6). ECGs were available for 45 (24%) of the therapy episodes 3-11 days after initiation of the antifungal therapy, 22 of which showed QTc prolongation. Regarding these 45 therapy episodes, sensitivity and specificity of the risk scores were calculated as follows: Tisdale 86%/22%, Vandael 91%/35%, Berger 32%/83%, Bindraban 50%/78%, Aboujaoude 14%/87%.
The QTc risk scores according to Tisdale and Vandael showed sufficient sensitivity for risk stratification in the studied patient population. In contrast, risk scores according to Berger, Bindraban, and Aboujaoude cannot be considered suitable due to poor sensitivity.
QTc 间期延长可导致潜在致命性心律失常。风险因素之一是 QTc 延长药物，包括一些常用于血液肿瘤患者的抗真菌药物。尚未在该患者人群中研究用于此类患者的风险筛查工具。
我们旨在评估在接受系统性抗真菌治疗的血液肿瘤患者中，五种 QTc 风险评分的敏感性和特异性。
从包括接受系统性抗真菌治疗的成年血液肿瘤患者的内部研究数据库中检索数据。回顾性收集与 QTc 延长药物、QTc 延长危险因素和心电图（ECG）相关的数据，为期 12 个月。计算了根据 Tisdale、Vandael、Berger、Bindraban 和 Aboujaoude 的 QTc 风险评分，以及它们的敏感性和特异性。
在所评估的时间段内，77 例患者接受了系统性抗真菌治疗，共发生了 187 个治疗期。就治疗期而言，中位年龄为 56 岁（四分位距 44-68），41%（77）为女性，中位处方 3 种（范围 0-6）QTc 延长药物。在开始抗真菌治疗后 3-11 天，45 个（24%）治疗期可获得 ECG，其中 22 个显示 QTc 延长。就这 45 个治疗期而言，风险评分的敏感性和特异性计算如下：Tisdale 86%/22%、Vandael 91%/35%、Berger 32%/83%、Bindraban 50%/78%、Aboujaoude 14%/87%。
在研究的患者人群中，Tisdale 和 Vandael 的 QTc 风险评分具有足够的敏感性用于风险分层。相比之下，根据 Berger、Bindraban 和 Aboujaoude 的风险评分敏感性较差，不能认为是合适的。
