The Association of Proton Pump Inhibitors and QT Interval Prolongation in Critically Ill Patients

医学 QT间期 延长 内科学 重症监护室 泮托拉唑 尖端扭转 室性心动过速 置信区间 长QT综合征 心脏病学 奥美拉唑
作者
Weiguo Fan,Hualong Liu,Yang Shen,Kui Hong
出处
期刊:Cardiovascular Drugs and Therapy [Springer Nature]
卷期号:38 (3): 517-525 被引量:6
标识
DOI:10.1007/s10557-023-07425-4
摘要

Drug-induced QT interval prolongation has been reported to be related to life-threatening polymorphic ventricular tachycardia (torsade de pointes). Proton pump inhibitors (PPIs) are prescribed widely for hospitalized patients; the QT interval prolongation and torsade de pointes caused by PPIs were reported. We conducted a study to determine the association between PPI treatment and QT interval prolongation in critically ill patients. This study included patients with electrocardiography (ECG) reports from the Medical Information Mart for Intensive Care III database (MIMIC-III). Patients younger than 18 years, missing baseline laboratories and with QT interval prolongation before intensive care unit (ICU) admission were excluded. The end point was the diagnosis of QT interval prolongation reported by ECG. This study included 24,512 ICU patients. Of them, 11,327 patients were treated with PPIs, 4181 with histamine 2 receptor antagonists (H2RAs) and 6351 without acid suppression therapy (non-AST); the incidence of QT interval prolongation were 8.5%, 3.3% and 3.4% respectively. After adjustment for demographics, electrolytes, comorbidities and medications, PPIs were associated a higher risk of QT interval prolongation compared with H2RAs (OR 1.66, 95% CI 1.36 − 2.03) and non-AST (OR 1.54, 95% CI 1.31 − 1.82), while there was not significant difference between H2RAs and non-AST (OR 0.93, 95% CI 0.73 − 1.17). In the propensity score matching population, the results were consistent. Pantoprazole (OR 2.14, 95% CI 1.52 − 3.03) and lansoprazole (OR 1.80, 95% CI: 1.18 − 2.76) showed a higher QT prolongation risk than omeprazole. Several drugs caused higher QT prolongation risk when used in combination with PPIs. In ICU patients, the association between PPI prescription and increased risk of QT interval prolongation was independent of known QT-prolonging factors; pantoprazole and lansoprazole had a higher risk compared with omeprazole. The combination of PPIs and other QT-prolonging drugs should be avoided.
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