Prognostic impact of sustained new-onset atrial fibrillation in critically ill patients
Prognostic impact of sustained new-onset atrial fibrillation in critically ill patients
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DOI：
10.1007/s00134-019-05822-8
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发表时间：
2019-11-04
影响因子：
38.9
通讯作者：
Nakasone, Masato
中科院分区：
文献类型：
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作者：
Yoshida, Takuo;Uchino, Shigehiko;Nakasone, Masato
目的危重患者新发心房颤动（AF）可能与不良结局相关。然而，尚不清楚持续新发AF是否会导致更差的结局。本研究的目的是评估持续性新发AF是否与卒中和死亡相关，并寻找AF持续时间和死亡之间可能的剂量反应关系。方法在2017年至2018年在日本32家重症监护室进行的一项前瞻性队列研究中，我们招募了新发AF的成人患者。我们比较了AF持续时间长于48 h的患者与AF持续时间短于48 h的患者。为了评估房颤持续时间和住院死亡率之间的剂量反应关系，我们进行了里程碑分析和时间依赖性考克斯回归分析。结果423例新发房颤患者中，院内死亡率为25%，院内脑卒中发生率为4.6%。房颤持续时间超过48小时与住院死亡率无独立相关性（校正比值比：1.52; 95%置信区间：0.87-2.64）。AF持续时间超过48小时的患者的院内卒中发生率为7.6%，AF持续时间短于48小时的患者为3.8%（p = 0.154）。当更连续地分析时间时，我们观察到AF持续时间与住院死亡率之间存在时间依赖性相关性（界标分析p = 0.005，考克斯分析p = 0.019）。结论持续新发AF与ICU患者的住院死亡率呈时间依赖性相关，尽管存在一些不确定性，因为AF持续时间超过48 h与住院死亡或卒中无关。
Purpose The development of new-onset atrial fibrillation (AF) in critically ill patients may be associated with poor outcomes. However, it is unknown whether sustained new-onset AF contributes to worse outcome. The aim of this study was to assess whether sustained new-onset AF is associated with stroke and death and to look for a possible dose-response relationship between AF duration and death. Methods In a prospective cohort study conducted in 32 intensive care units in Japan from 2017 to 2018, we enrolled adult patients with new-onset AF. We compared patients with AF duration longer than 48 h with those with AF duration shorter than 48 h. To assess a dose-response relationship between AF duration and hospital mortality, we conducted landmark analysis and time-dependent Cox regression analysis. Results Among a total of 423 new-onset AF patients, hospital mortality was 25%, and the incidence of in-hospital stroke was 4.6%. AF duration longer than 48 h was not independently associated with hospital mortality (adjusted odds ratio: 1.52; 95% Confidence Interval: 0.87-2.64). The incidence of in-hospital stroke was 7.6% in patients with AF duration longer than 48 h and 3.8% in those with AF duration shorter than 48 h (p = 0.154). When analyzing time more continuously, we observed a time-dependent association between AF duration and hospital mortality (p = 0.005 by landmark analysis and p = 0.019 by Cox analysis). Conclusions Sustained new-onset AF was time-dependently associated with hospital mortality in ICU patients, albeit with some uncertainty since AF duration longer than 48 h was not independently associated with in-hospital death or stroke.