General hospital psychiatry · 2026
Short-term ECG safety after inpatient initiation of sertraline versus citalopram or escitalopram: An observational target-trial emulation using MIMIC-IV-ECG.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Lin Junyi, Zhang Ting
Аннотация
BACKGROUND: In general hospital and consultation-liaison psychiatry settings, sertraline is often preferred over citalopram or escitalopram when QT risk is a concern. Whether this routine preference yields a clinically meaningful short-term electrocardiographic (ECG) advantage after baseline ECG screening and inpatient monitoring is uncertain.
METHODS: We conducted a new-user, active-comparator target trial emulation using MIMIC-IV and MIMIC-IV-ECG. Adults initiating sertraline or citalopram/escitalopram with a baseline 12‑lead ECG within 48 h were included. The primary endpoint was 7-day detected ECG safety deterioration; Fridericia-corrected QT interval (QTcF)-specific events were the key mechanistic endpoint. Inverse-probability-of-treatment weighting estimated risk differences and ratios.
RESULTS: Among 4921 patients, the broad detected ECG composite occurred in 349 (7.1%), with risk difference (RD) -0.36% (95% confidence interval [CI], -1.81% to 1.12%). QTcF-specific events occurred in 50 (1.0%), with RD -0.59% (95% CI, -1.11% to -0.03%). QTcB sensitivity did not support the same direction of advantage. Follow-up ECG acquisition was clinically driven but similar between groups.
LIMITATIONS: Residual confounding, clinically driven follow-up ECG ascertainment, machine-measured intervals, and absent psychiatric severity measures limit interpretation.
CONCLUSIONS: Sertraline showed modestly lower QTcF-specific event risk but no large advantage for the broader detected ECG safety composite. Findings support ECG- and electrolyte-guided prescribing rather than automatic switching based on a fixed QT-risk hierarchy.
METHODS: We conducted a new-user, active-comparator target trial emulation using MIMIC-IV and MIMIC-IV-ECG. Adults initiating sertraline or citalopram/escitalopram with a baseline 12‑lead ECG within 48 h were included. The primary endpoint was 7-day detected ECG safety deterioration; Fridericia-corrected QT interval (QTcF)-specific events were the key mechanistic endpoint. Inverse-probability-of-treatment weighting estimated risk differences and ratios.
RESULTS: Among 4921 patients, the broad detected ECG composite occurred in 349 (7.1%), with risk difference (RD) -0.36% (95% confidence interval [CI], -1.81% to 1.12%). QTcF-specific events occurred in 50 (1.0%), with RD -0.59% (95% CI, -1.11% to -0.03%). QTcB sensitivity did not support the same direction of advantage. Follow-up ECG acquisition was clinically driven but similar between groups.
LIMITATIONS: Residual confounding, clinically driven follow-up ECG ascertainment, machine-measured intervals, and absent psychiatric severity measures limit interpretation.
CONCLUSIONS: Sertraline showed modestly lower QTcF-specific event risk but no large advantage for the broader detected ECG safety composite. Findings support ECG- and electrolyte-guided prescribing rather than automatic switching based on a fixed QT-risk hierarchy.