Tisdale-score-based risk stratification of QTc prolongations in hospitalized patients receiving azole antifungal therapy—a retrospective study

Steinbrech, Julian; Amann, Ute; Irlbeck, Michael; Clauss, Sebastian; Strobach, Dorothea (2026): Tisdale-score-based risk stratification of QTc prolongations in hospitalized patients receiving azole antifungal therapy—a retrospective study. Frontiers in Cardiovascular Medicine, 13: 1685152. ISSN 2297-055X

Abstract

Background:

QTc prolongation can trigger potentially lethal arrhythmias. Almost all azole antifungals, which are used in vulnerable patients, prolong the QTc interval and thus, may increase arrhythmia risk. The Tisdale-risk-score allows to identify patients at risk for drug-induced QTc prolongation but has not yet been investigated in this patient population.

Objective:

To evaluate the sensitivity and specificity of the Tisdale-score with regard to detected QTc prolongations in patients prescribed systemic azole antifungals.

Methods:

For six months (12/23-05/24), prescriptions of systemic azole antifungals were retrospectively recorded in adult inpatients of all medical specialties of a university hospital. Risk factors for QTc prolongation, including concomitant drugs and ECGs, were documented and the Tisdale-score and its sensitivity and specificity were calculated.

Results:

In the study period, 319 systemic azole prescriptions (cases) were recorded for 259 patients. The median age of all cases was 61 years, 45% (143) were female. Including the systemic azole, a prescription of ≥2 QT-drugs was present in 283 (89%) cases. The median Tisdale-score was 7 (moderate risk). ECGs after azole initiation were available in 149 cases. Out of these, relevant QTc prolongations occurred in 7 cases (4.7%). Sensitivity of the Tisdale-score was 100%, specificity 30%.

Conclusion:

Patients prescribed systemic azole antifungals are at risk of QTc prolongation due to regular use of multiple QT-drugs. However, relevant QTc prolongations were rare in the patient population studied. The Tisdale-score achieved a good sensitivity for the identification of patients at risk for QTc prolongation.

• Dokumententyp: Artikel (Klinikum der LMU)
• Organisationseinheit (Fakultäten): 18 Chemie und Pharmazie > Department für Pharmazie - Zentrum für Pharmaforschung; 07 Medizin > Klinikum der LMU München > Klinik für Anaesthesiologie; 07 Medizin > Klinikum der LMU München > Medizinische Klinik und Poliklinik I (Kardiologie)
• DFG-Fachsystematik der Wissenschaftsbereiche: Lebenswissenschaften
• DFG: Gefördert durch die Deutsche Forschungsgemeinschaft (DFG) - 491502892