잠시만 기다려 주세요. 로딩중입니다.

향정신성 약물 중독에 의한 QTc 연장과 그 위험성에 대한 고찰

QTc Prolongation due to Psychotropic Drugs Intoxication and Its Risk Assessment

대한임상독성학회지 2020년 18권 2호 p.66 ~ 77
박관호, 홍훈표, 이종석, 정기영, 고석훈, 김성규, 최한성,
소속 상세정보
박관호 ( Park Kwan-Ho ) - Kyung Hee University Hospital Department of Emergency Medicine
홍훈표 ( Hong Hoon-Pyo ) - Kyung Hee University Hospital Department of Emergency Medicine
이종석 ( Lee Jong-Seok ) - Kyung Hee University Hospital Department of Emergency Medicine
정기영 ( Jeong Ki-Young ) - Kyung Hee University Hospital Department of Emergency Medicine
고석훈 ( Ko Seok-Hun ) - Kyung Hee University Hospital Department of Emergency Medicine
김성규 ( Kim Sung-Kyu ) - Kyung Hee University Hospital Department of Emergency Medicine
최한성 ( Choi Han-Sung ) - Kyung Hee University Hospital Department of Emergency Medicine

Abstract


Purpose: The aims of the present study were twofold. First, the research investigated the effect of an individual’s risk factors and the prevalence of psychotropic drugs on QTc prolongation, TdP (torsades de pointes), and death. Second, the study compared the risk scoring systems (the Mayo Pro-QT risk score and the Tisadale risk score) on QTc prolongation.

Methods: The medical records of intoxicated patients who visited the emergency department between March 2010 and February 2019 were reviewed retrospectively. Among 733 patients, the present study included 426 psychotropic drug-intoxicated patients.
The patients were categorized according to the QTc value. The known risk factors of QTc prolongation were examined, and the Mayo Pro-QT risk score and the Tisadale risk score were calculated. The analysis was performed using multiple logistic regression, Spearman correlation, and ROC (receiver operating characteristic).

Results: The numbers in the mild to moderate group (male: 470≤QTc<500 ms, female: 480≤QTc<500 ms) and severe group (QTc≥500 ms or increase of QTc at least 60ms from baseline, both sex) were 68 and 95, respectively. TdP did not occur, and the only cause of death was aspiration pneumonia. The statically significant risk factors were multidrug intoxications of TCA (tricyclic antidepressant), atypical antipsychotics, an atypical antidepressant, panic disorder, and hypokalemia. The Tisadale risk score was larger than the Mayo Pro-QT risk score.

Conclusion: Multiple psychotropic drugs intoxication (TCA, an atypical antidepressant, and atypical antipsychotics), panic disorder, and hypokalemia have been proven to be the main risk factors of QTc prolongation, which require enhanced attention. The present study showed that the Tisadale score had a stronger correlation and predictive accuracy for QTc prolongation than the Mayo Pro-QT score. As a result, the Tisadale risk score is a crucial assessment tool for psychotropic drug-intoxicated patients in a clinical setting.

키워드

Psychotropic drugs; QTc prolongation; Torsades de pointes; Mayo Pro-QT score

원문 및 링크아웃 정보

등재저널 정보