PDF(Pubmed)
Abstract：
BACKGROUND: Ondansetron is one of the most commonly used drugs in the emergency department (ED) for treating nausea and vomiting, particularly in intravenous (IV) form. Nevertheless, it has been shown to prolong QT interval and increase the risk of ventricular dysrhythmias. This study evaluated the associations between single IV ondansetron dosage and subsequent QTc prolongation in the ED.
METHODS: In this prospective observational study, a total number of 106 patients presenting to the ED in a 3-month period with nausea and vomiting treated with IV ondansetron were enrolled. QT and QTc intervals were measured at baseline (QT0 and QTc0), and 60 min (QT60 and QTc60) following a single-dose administration of ondansetron at 4 or 8 mg doses. To evaluate the predictive ability of these variables, we employed receiver operating characteristic (ROC) curve analyses.
RESULTS: The predictive models for QTc prolongation 1-hour post-ondansetron administration showed the following: at baseline, the area under curve of 0.70 for QT, 0.71 for QTc, and 0.64 for dosage. Conversely, a QTc0 = 375 msec indicated a QTc60 > 480 msec with a specificity of 97%. Additionally, a QTc0 of 400 msec had a sensitivity of 100% in predicting a QTc60 < 480 msec, while a QTc0 > 460 msec predicted a QTc60 > 480 msec with a specificity of 98%. Moreover, 8 mg doses were associated with higher rates of QTc60 prolongation, while 4 mg doses favored maintaining QTc60 within normal limits.
CONCLUSIONS: Our study demonstrates the predictive capacity of QT0, QTc0, and ondansetron dosage in forecasting QTc60 prolongation (> 480 msec) post-ondansetron administration. These findings advocate for their incorporation into clinical protocols to enhance safety monitoring in adult ED patients.
METHODS: In this prospective observational study, a total number of 106 patients presenting to the ED in a 3-month period with nausea and vomiting treated with IV ondansetron were enrolled. QT and QTc intervals were measured at baseline (QT0 and QTc0), and 60 min (QT60 and QTc60) following a single-dose administration of ondansetron at 4 or 8 mg doses. To evaluate the predictive ability of these variables, we employed receiver operating characteristic (ROC) curve analyses.
RESULTS: The predictive models for QTc prolongation 1-hour post-ondansetron administration showed the following: at baseline, the area under curve of 0.70 for QT, 0.71 for QTc, and 0.64 for dosage. Conversely, a QTc0 = 375 msec indicated a QTc60 > 480 msec with a specificity of 97%. Additionally, a QTc0 of 400 msec had a sensitivity of 100% in predicting a QTc60 < 480 msec, while a QTc0 > 460 msec predicted a QTc60 > 480 msec with a specificity of 98%. Moreover, 8 mg doses were associated with higher rates of QTc60 prolongation, while 4 mg doses favored maintaining QTc60 within normal limits.
CONCLUSIONS: Our study demonstrates the predictive capacity of QT0, QTc0, and ondansetron dosage in forecasting QTc60 prolongation (> 480 msec) post-ondansetron administration. These findings advocate for their incorporation into clinical protocols to enhance safety monitoring in adult ED patients.
摘要：
背景：昂丹司琼是急诊科（ED）最常用的治疗恶心和呕吐的药物之一，特别是静脉内（IV）形式。然而，它已被证明可以延长QT间期并增加室性心律失常的风险。这项研究评估了ED中单次IV昂丹司琼剂量与随后的QTc延长之间的关联。
方法：在这项前瞻性观察研究中，共纳入106例ED患者,这些患者在3个月内出现恶心和呕吐,并接受了昂丹司琼静脉注射治疗.在基线测量QT和QTc间隔（QT0和QTc0），单剂量给予4或8mg剂量的昂丹司琼60分钟（QT60和QTc60）。为了评估这些变量的预测能力，我们采用接收器工作特性(ROC)曲线分析。
结果：恩丹西酮给药后1小时QTc延长的预测模型显示：在基线，QT的曲线下面积为0.70，QTc为0.71，和0.64的剂量。相反，aQTc0=375毫秒表示QTc60>480毫秒,特异性为97%。此外,400毫秒的QTc0在预测QTc60<480毫秒时具有100%的灵敏度，而QTc0>460毫秒预测QTc60>480毫秒，特异性为98%。此外，8mg剂量与较高的QTc60延长率相关，而4毫克剂量有利于将QTc60维持在正常范围内。
结论：我们的研究证明了QT0，QTc0和昂丹司琼剂量在预测昂丹司琼给药后QTc60延长（>480毫秒）方面的预测能力。这些发现主张将其纳入临床方案，以增强成年ED患者的安全性监测。
方法：在这项前瞻性观察研究中，共纳入106例ED患者,这些患者在3个月内出现恶心和呕吐,并接受了昂丹司琼静脉注射治疗.在基线测量QT和QTc间隔（QT0和QTc0），单剂量给予4或8mg剂量的昂丹司琼60分钟（QT60和QTc60）。为了评估这些变量的预测能力，我们采用接收器工作特性(ROC)曲线分析。
结果：恩丹西酮给药后1小时QTc延长的预测模型显示：在基线，QT的曲线下面积为0.70，QTc为0.71，和0.64的剂量。相反，aQTc0=375毫秒表示QTc60>480毫秒,特异性为97%。此外,400毫秒的QTc0在预测QTc60<480毫秒时具有100%的灵敏度，而QTc0>460毫秒预测QTc60>480毫秒，特异性为98%。此外，8mg剂量与较高的QTc60延长率相关，而4毫克剂量有利于将QTc60维持在正常范围内。
结论：我们的研究证明了QT0，QTc0和昂丹司琼剂量在预测昂丹司琼给药后QTc60延长（>480毫秒）方面的预测能力。这些发现主张将其纳入临床方案，以增强成年ED患者的安全性监测。
