QT-prolongation as an indicator of complications in malaria

Introduction: There has always been a search for marker for predicting the complications of malaria. Electrocardiography (ECG) is a simple, easily available investigation, and QT-prolongation on ECG is a known marker of severity in many diseases. Aim: This study aimed to assess the association between QT interval prolongation and complications in malaria. Materials and Methods: This retrospective record-based study included 92 patients diagnosed with malaria by smear and was conducted from January to December 2013. The normal-corrected QT interval (QTC) was taken as 0.44 s (440 ms). Data were analyzed for association using Chi-square test and multivariate logistic regression model. Results: Mean QTC of the study group was 413.08 ± 34.8 ms. A total of 12 patients had QTC >440 ms, of them 10 had associated complications. Among 80 patients with normal QTC, 17 had complications associated with P < 0.001. Specificity of prolonged QTC for identifying complicated malaria was 83.33%, and sensitivity was 37.03%. On multivariate logistic regression model with QTC interval as the dependent variable, QTC was significantly associated with acute kidney injury (AKI) (P = 0.036) and Plasmodium vivax malaria (P = 0.01). Conclusions: Prolonged QTC has high specificity and low sensitivity for patients with complicated malaria. Prolonged QTC is significantly associated with vivax malaria and AKI in malaria. Hence, malaria patients with prolonged QTC should be more carefully watched for complications.