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Volume 41 Issue 7
Jul.  2025
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Article Navigation >  Journal of Clinical Hepatology  > 2025  >  41(7): 1371-1379

Predictive value of QTc for short-term prognosis in patients with cirrhotic ascites

DOI: 10.12449/JCH250722
  • 1.

    School of Public Health，Dali University，Dali，Yunnan 671000，China

  • 2.

    General Department of Hepatology，The Third People’s Hospital of Kunming，Kunming 650000，China

Research funding:

Regional Science Foundation of National Natural Science Foundation of China (82260408);

Scientific Research Foundation of Yunnan Education Department (2024J0863);

Social Development and Technology Benefit Program Project of Kunming Science and Technology Bureau (2023-1-NS-002)

More Information
  • Corresponding author: LI Shenghao， doctorlee3h@163.com （ORCID： 0000-0003-1207-3226）; WANG Qingqing， wangqingqing1511@163.com （ORCID： 0000-0001-8033-3216）
  • Received Date: 2024-11-28
  • Accepted Date: 2025-03-03
  • Published Date: 2025-07-25
    Abstract
  •   Objective  To explore the relationship between corrected QT interval （QTc） and short-term mortality rate in patients with cirrhotic ascites and the predictive value of QTc combined with Child-Pugh class for short-term death.  Methods  Patients hospitalized with cirrhotic ascites from October 2022 to March 2024 were selected as study subjects （training set， n=245）， and similar patients from April to October 2024 were included for external validation （validation set， n=88）. Patients’ demographic data， basic clinical data， and first electrocardiography related indicators on admission were collected. Patients were divided into a death group and a survival group according to the 30-day follow-up result. The influencing factors for prognosis were explored by Lasso regression and univariate and multivariate binary logistic regression. A death risk nomogram model was constructed and evaluated by receiver operating characteristic curve （ROC curve）， calibration curve， and decision curve. Data were analyzed for normality using Shapiro-Wilk test. Pairwise comparison for continuous data that were normally distributed was conducted by the independent-samples t test. Pairwise comparison for continuous data that were not normally distributed was conducted by the Mann-Whitney U test. Pairwise comparison for categorical data was performed using the chi-square test.  Results  The mortality rates were 35.1% （86/245） in the training set and 30.7% （27/88） in the validation set. Lasso regression showed that combined tumor， QTc， hematocrit， total bilirubin （TBil）， direct bilirubin， alkaline phosphatase， albumin， cholinesterase， high-density lipoprotein cholesterol， carcinoembryonic antigen， international normalized ratio， model for end-stage liver disease （MELD）， and Child-Pugh class were potential influencing factors for 30-day death in patients with cirrhotic ascites. Univariate and multivariate logistic regression showed that QTc （odds ratio［OR］=1.010， 95% confidence interval ［CI］：1.001‍ ‍—‍ ‍1.020，P=0.039）， presence of tumor （OR=6.904，95%CI：2.997‍ ‍—‍ ‍12.391，P<0.001）， TBil （OR=1.009，95%CI：1.004‍ ‍—‍ ‍1.014，P=0.001）， and Child-Pugh class （OR= 2.532，95%CI：1.256‍ ‍—‍ ‍5.105，P=0.009） were independent risk factors for 30-day death in patients with cirrhotic ascites. For the nomogram model constructed based on the results of the multivariate logistic analysis， the area under the ROC curve in the training set was 0.824； the sensitivity and specificity were 81.1% and 74.4%， respectively； the Hosmer-Lemeshow goodness-of-fit test showed P=0.673； the mean absolute error of the calibration curve was 0.020. The area under the ROC curve in the validation set was 0.886； the sensitivity and specificity were 91.8% and 70.4%， respectively； the Hosmer-Lemeshow goodness-of-fit test showed P=0.965； the mean absolute error of the calibration curve was 0.032. With the threshold probability of 0.15 to 0.85， the decision curve suggested a good benefit. The area under the ROC curve of the predictive model （0.824） was greater than conventional MELD score （0.700）， MELD-Na score （0.698）， and Child-Pugh score （0.674） （all P<0.05）.  Conclusion  QTc is an independent predictor of short-term death in patients with cirrhotic ascites， and the prognostic model including QTc and Child-Pugh class has a good predictive value for short-term mortality rate.

     

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