Multivariate analysis of risk factors for QT prolongation following subarachnoid hemorrhage

Abstract

Background: Subarachnoid hemorrhage (SAH) often causes a prolongation of the corrected QT (QTc) interval during the acute phase. The aim of the present study was to examine independent risk factors for QTc prolongation in patients with SAH by means of multivariate analysis.

Method: We studied 100 patients who were admitted within 24 hours after onset of SAH. Standard 12-lead electrocardiography (ECG) was performed immediately after admission. QT intervals were measured from the ECG and were corrected for heart rate using the Bazett formula. We measured serum levels of sodium, potassium, calcium, adrenaline (epinephrine), noradrenaline (norepinephrine), dopamine, antidiuretic hormone, and glucose.

Results: The average QTc interval was 466 +/- 46 ms. Patients were categorized into two groups based on the QTc interval, with a cutoff line of 470 ms. Univariate analyses showed significant relations between categories of QTc interval, and sex and serum concentrations of potassium, calcium, or glucose. Multivariate analyses showed that female sex and hypokalemia were independent risk factors for severe QTc prolongation. Hypokalemia (<3.5 mmol/l) was associated with a relative risk of 4.53 for severe QTc prolongation as compared with normokalemia, while the relative risk associated with female sex was 4.45 as compared with male sex. There was a significant inverse correlation between serum potassium levels and QTc intervals among female patients.

Conclusion: These findings suggest that female sex and hypokalemia are independent risk factors for severe QTc prolongation in patients with SAH.

Figure 1

Correlation between serum potassium levels and corrected QT (QTc) intervals in 100 patients with subarachnoid hemorrhage (SAH). (a) There was a significant inverse correlation between serum potassium levels and QTc intervals (Pearson's correlation coefficient r = -0.439, P < 0.0001) among all SAH patients. Furthermore, we evaluated the impact of sex on the correlation between serum potassium levels and QTc interval. (c) Among female SAH patients there was a significant inverse correlation between serum potassium levels and QTc intervals (r = -0.474; P < 0.0001). (b) On the other hand, there was no significant correlation between serum potassium levels and QTc intervals among male SAH patients.