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

• Published in: Cardiovascular drugs and therapy 2024-06, Vol.38 (3), p.517-525
• Main Authors: Fan, Weiguo, Liu, Hualong, Shen, Yang, Hong, Kui
• Format: Article
• Language: English
• Subjects: Aged; Cardiology; Comorbidity; Critical Illness; Databases, Factual; Demographics; Drugs; EKG; Electrocardiography; Electrolytes; Female; Histamine H2 Antagonists - adverse effects; Humans; Incidence; Inhibitors; Intensive care; Intensive Care Units; Long QT Syndrome - chemically induced; Long QT Syndrome - epidemiology; Male; Medicine; Medicine & Public Health; Middle Aged; Omeprazole; Original Article; Patients; Prolongation; Proton pump inhibitors; Proton Pump Inhibitors - adverse effects; Protons; Retrospective Studies; Risk; Risk Factors; Tachycardia; Torsades de pointes; Torsades de Pointes - chemically induced; Torsades de Pointes - epidemiology
• ISSN: 0920-3206; 1573-7241
• DOI: 10.1007/s10557-023-07425-4

Introduction 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. Methods 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. Results This study included 24,512 ICU patients. Of them, 11,327 patients were treated with PPIs, 4181 with histamine 2 receptor antagonists (H 2 RAs) 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 H 2 RAs (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 H 2 RAs 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. Conclusion 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.