Risk factors and outcomes associated with new-onset atrial fibrillation during acute respiratory distress syndrome.
Risk factors and outcomes associated with new-onset atrial fibrillation during acute respiratory distress syndrome.
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DOI：
10.1016/j.jcrc.2015.06.003
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发表时间：
2015-10
影响因子：
3.7
通讯作者：
Walkey AJ
中科院分区：
文献类型：
--
作者：
Ambrus DB;Benjamin EJ;Bajwa EK;Hibbert KA;Walkey AJ
在急性呼吸窘迫综合征(ARDS)期间，与新发房颤(AF)相关的预后和危险因素尚不清楚。我们调查了ARDS期间与新发房颤相关的死亡率和危险因素。我们从ARDS网络沙丁胺醇治疗急性肺损伤(ALTA)试验中获得数据，该试验前瞻性地将ARDS患者中新发的房颤确定为不良事件。我们确定了APACHE III调整后的新发房颤与90天死亡率之间的关联。我们还检查了新发房颤与炎症标记物[白介素6、白介素8]、心肌损伤(肌钙蛋白-I)、自主神经激活(肾上腺素)、心房拉伸(中心静脉压)以及其他临床特征之间的关系。在参加ALTA试验的282名患者(平均年龄51.6岁，女性占45%，白人占77%)中，28名(10%)在研究期间发生了新发的房颤。我们未发现新发房颤与基线中心静脉压、血浆肌钙蛋白-I、肾上腺素、白介素6或白介素8水平之间的关系。ARDS期间新发房颤与90天死亡率增加相关[新发房颤43%与无新发房颤19%，APACHE调整的优势比：3.09(95%可信区间1.24-7.72)，p=0.02]。ARDS期间新发的房颤与死亡率增加有关，然而，其机制尚需进一步研究。
Outcomes and risk factors associated with new-onset atrial fibrillation (AF) during acute respiratory distress syndrome (ARDS) are unclear. We investigated mortality and risk factors associated with new-onset AF during ARDS. We obtained data from the ARDS Network Albuterol for Treatment of Acute Lung Injury (ALTA) trial, which prospectively identified new-onset AF among patients with ARDS as an adverse event. We determined APACHE III-adjusted associations between new-onset AF and 90-day mortality. We also examined associations between new-onset AF and markers of inflammation [interleukin-6, interleukin-8], myocardial injury (troponin-I), autonomic activation (epinephrine), and atrial stretch (central venous pressure), as well as other clinical characteristics. Of 282 patients (mean age 51.6 years, 45% women, 77% white) enrolled in ALTA, 28 (10%) developed new-onset AF during the study. We did not identify associations between new-onset AF and baseline central venous pressure, plasma levels of troponin-I, epinephrine, interleukin-6, or interleukin-8. New-onset AF during ARDS was associated with increased 90-day mortality [new-onset AF 43% vs. no new-onset AF 19%, APACHE-adjusted odds ratio: 3.09 (95% CI 1.24–7.72), p=0.02]. New-onset AF during ARDS is associated with increased mortality, however, its mechanisms require further study.