Background The objective of this study was to investigate the correlation between prothrombin time‐international normalized ratio to albumin ratio (PTAR) and QTc prolongation and to evaluate the predictive value of PTAR for long‐term clinical outcomes in patients with liver cirrhosis. Methods Data from participants with liver cirrhosis admitted to Southwest Hospital between April 2017 and April 2018 were included in this study. The association between PTAR and QTc prolongation was examined using univariate and multivariable logistic regression analyses. The restricted cubic spline (RCS) method was employed for curve fitting and to determine the optimal PTAR threshold for predicting QTc prolongation. The SHapley Additive exPlanations (SHAP) algorithm, based on multivariable logistic regression, was utilized to assess the feature importance of PTAR. Kaplan–Meier curves and Cox proportional hazards models were used to evaluate the prognostic value of PTAR for liver‐related decompensation and severe arrhythmia. Results Among the 374 participants (mean age 56.7 years; 66.3% male), 41.4% (155/374) experienced QTc prolongation. The median QT interval was 402.9 ± 41.9 ms. An adverse L‐shaped curve association between PTAR and QTc prolongation was observed, with an inflection point at 37.40. The odds ratio (OR) for developing QTc prolongation was 1.17 (95% CI: 1.06–1.28, p = 0.001) as PTAR ranged from 0 to 37.40. Interestingly, a threshold of 37.40 was also identified for predicting QTc prolongation, with PTAR achieving an area under the receiver operating characteristic curve (AUC) of 0.66. According to the feature importance ranking based on the SHAP algorithm, PTAR emerged as the most significant predictor, followed by sex, TBIL, and the etiology of liver cirrhosis. During a median follow‐up of 502 days, patients in the high PTAR group had a significantly higher risk of liver‐related decompensation (HR 3.51, 95% CI 2.35–5.24) and severe arrhythmia (HR 2.34, 95% CI 1.57–3.48) compared to the low PTAR group. Conclusion There is a significant correlation between PTAR and QTc prolongation in patients with liver cirrhosis. An inflection point at 37.40 was identified, at which PTAR showed strong predictive value for QTc prolongation. Furthermore, elevated PTAR serves as a robust independent predictor for long‐term liver‐related decompensation and severe arrhythmia.
Lu et al. (Thu,) studied this question.