Exploring the independent factors influencing prolonged QTc intervals in patients with acute-on-chronic liver failure caused by hepatitis B

Prolonged QTc interval is a common electrophysiological abnormality in patients with chronic liver disease, but limited evidence exists regarding its occurrence in acute-on-chronic liver failure (ACLF), particularly in hepatitis B virus–related ACLF (HBV-ACLF). Given the rapid progression, high mortality, and severe complications associated with ACLF, understanding cardiac electrophysiological changes is clinically important. This study aimed to determine the incidence of QTc prolongation in patients with HBV-ACLF and to identify independent factors associated with QTc abnormalities. A retrospective study was conducted on 206 consecutive patients with HBV-ACLF admitted between January 2016 and December 2023. Heart rate and QT interval data were obtained from 12-lead electrocardiograms performed at admission. QTc was calculated using Bazett’s formula. Patients were categorized into prolonged and non-prolonged QTc groups using a cutoff of 440 ms. Demographic, clinical, and laboratory variables were compared, and significant factors ( P  P  P  < .05 for all). Approximately one-third of patients with HBV-ACLF demonstrated prolonged QTc intervals. Electrolyte imbalance, renal dysfunction, viral replication activity, and ascites were independently associated with QTc prolongation. Routine QTc monitoring may provide a simple and noninvasive tool for early identification of patients at increased risk of cardiac complications.