The association between proton pump inhibitor prescription and QT interval prolongation in intensive care unit patients

Introduction: Drug-induced QT interval prolongation has been reported to be related tolife-threatening polymorphic ventricular tachycardia (torsade de pointes). Proton pump inhibitors (PPIs) are prescribed widelyfor hospitalized patients, the QT interval prolongation and torsade de pointes caused by PPIs were reported. We tried to explore whether PPIs can increase the risk of QT interval prolongation among intensive care unit (ICU) 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 and those with missing laboratory results were excluded. The end point was QT interval prolongation according to ECG reports. Results: This study included 84,653 ECG reports of 25,426 ICU patients, 14,520 (57.1%) patients had been prescribed PPIs and 2,271 (8.93%) showed a prolonged QT interval. Patients treated with PPIs had a higher incidence of QT interval prolongation (11.17% vs. 5.95%; odd ratio [OR] 1.99, 95% CI: 1.81-2.19; P < 0.001) than those absent PPIs prescription. PPI treatment was associated with an increased risk of QT interval prolongation (OR 1.45, 95% CI: 1.30-1.62; P < 0.001) in adjusted logistic regression for serum potassium, serum magnesium, serum total calcium, estimated glomerular filtration rate (eGFR), comorbidities and known QT-prolonging drugs. In the matched population, patients treated with PPIs also had a higher risk of QT prolongation (8.74% vs. 6.29, OR 1.43, 95% CI: 1.23-1.66). Pantoprazole was associated with higher risk of QT interval prolongation compared with omeprazole and lansoprazole. Conclusion: There was an association between PPI prescription and QT interval prolongation in ICU patients, independent on known QT-prolonging factors. Pantoprazole had thehighest risk among three PPIs.