الفهرس 
SepsisOnly 14 pages are availabe for public view
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Abstract
Sepsis and septic shock are major healthcare problems, affecting millions of people around the world each year, and killing as many as one in four (and often more) of septic patients. Various studies have been carried out in the past to find out the frequency and clinical/biochemical variables associated with a prolonged QTc interval essentially in populations of patients with selected disease conditions.
The aim of our work is to study QT dispersion, QT interval abnormalities and corrected QT interval in septic patients in correlation with: arrhythmias, hospital outcome (survival, mortality) and electrolytes.
This study is a prospective randomized study that was conducted on patients who admitted to ICU in Ahmed Maher Teaching Hospital. Forty consecutive patients were included in this study and an informed written consent was obtained from patients and /or relatives. Patients admitted to ICU suffering from sepsis or had septic shock. Patients above 18 years old who were admitted at the ICU unit with evidence of sepsis which was defined by quick sequential organ failure assessment (qSOFA) score associated with infection were included. We exclude patients who had a previous episode of cardiopulmonary resuscitation, Arrhythmogenic drug therapy such as aminophylline, dopamine >5 mg/kg per min, or adrenaline and drugs that may prolong QT interval e.g: clarithromycin, Sotalol, Amiodarone. Patients were subjected to full history, clinical examination, and laboratory profile assessment. Follow-up of ECG changes in QT interval measurements.
All patients included in our study were adult, more than 18 years old, admitted to ICU suffering from sepsis or had septic shock (fulfilling inclusion criteria). Forty patients were included in this study, their ages with a mean of 53.50± 13.7 years. Male patients were 24(60%) and female patients were 16 (40%). The most frequent risk factors were hypertension (62.5%) followed by diabetes (55%) beside other risk factors as smoking and dyslipidemia. Mean values of QT dispersion were 51.45±15.09 and QTc interval were 46.12±10.60. QTc were normal in 25(62.5%) patients and Prolonged QT was in 15(37.5%) patients. Arrhythmias were represented as AF and Ventricular arrhythmia {12(30%) and 5(12.5%) respectively}. mean of GCS at admission was 10.87±3.20 Points. Mean of Quick SOFA score at admission was 2.47±0.59 points. Mechanical ventilation was needed in 17(42.5%). The mean length of ICU stay was 9.10±4.73days. Outcome of admitted patients in ICU was 24(60%) survived and 16(40%) non-survived patients. univariate analysis of all patient characteristics shows that Gender, QT dispersion and corrected QTc were predictors of mortality in our study, (p=0.018, 0.024 and 0.008) respectively. Multivariate analysis shows that Gender, QT dispersion and corrected QTc were not independent predictors of mortality in our study (p>0.05). comparison between normal QT and QT prolongations in the studied patients as regards variables of demographic, risk factors, and comorbidities have no statistical significant differences except for; gender {it was statistically significant (p>0.05)}. comparison between normal QT and QT prolongations as regards laboratory characteristics of studied patients; serum electrolytes have lower mean values in patients with prolonged QTc than normal QTc and statistically significant (Ca; p <0.001 and K; p=0.04). comparison between normal QT and QT prolongations as regards follow-up in ICU showed that ventricular arrhythmias and mortality were higher in patients with prolonged QTc and were statistically significant (p=0.036 and p=0.008) respectively.
This study was planned to find out the prevalence and prognostic significance of QTc prolongation in patients with sepsis in ICU. We found that the QTc duration may act as a risk marker in the septic patient. Patients with markedly prolonged QTc interval had significantly more episodes of in‑hospital ventricular tachycardia and hospital mortality.