Prognostic impact of sustained new-onset atrial fibrillation in critically ill patients

被引：20

作者：

Yoshida, Takuo ^{[1
]}

Uchino, Shigehiko ^{[1
]}

Sasabuchi, Yusuke ^{[2
]}

Hagiwara, Yasuhiro ^{[3
]}

Yoshida, Tomonao ^{[4
]}

Nashiki, Hiroshi ^{[5
]}

Suzuki, Hajime ^{[6
]}

Takahashi, Hiroshi ^{[7
]}

Kishihara, Yuki ^{[8
]}

Nagasaki, Shinya ^{[9
]}

Okazaki, Tomoya ^{[10
]}

Katayama, Shinshu ^{[11
]}

Sakuraya, Masaaki ^{[12
]}

Ogura, Takayuki ^{[13
]}

Inoue, Satoki ^{[14
]}

Uchida, Masatoshi ^{[15
]}

Osaki, Yuka ^{[16
]}

Kuriyama, Akira ^{[17
]}

Irie, Hiromasa ^{[17
]}

Kyo, Michihito ^{[18
]}

Shima, Nozomu ^{[19
]}

Saito, Junichi ^{[20
]}

Nakayama, Izumi ^{[21
]}

Jingushi, Naruhiro ^{[22
]}

Nishiyama, Kei ^{[23
]}

Masuda, Takahiro ^{[24
]}

Tsujita, Yasuyuki ^{[25
]}

Okumura, Masatoshi ^{[26
]}

Inoue, Haruka ^{[27
]}

Aoki, Yoshitaka ^{[28
]}

Kondo, Takashiro ^{[29
]}

Nagata, Isao ^{[30
]}

Igarashi, Takashi ^{[31
]}

Saito, Nobuyuki ^{[32
]}

Nakasone, Masato ^{[33
]}

机构：

[1] Jikei Univ, Dept Anesthesiol, Intens Care Unit, Sch Med,Minato Ku, Tokyo 1058471, Japan

[2] Jichi Med Univ, Data Sci Ctr, Shimotsuke, Tochigi, Japan

[3] Univ Tokyo, Dept Biostat, Tokyo, Japan

[4] Hokkaido Univ, Sapporo, Hokkaido, Japan

[5] Iwate Prefectural Cent Hosp, Morioka, Iwate, Japan

[6] Saitama Red Cross Hosp, Saitama, Japan

[7] Steel Mem Muroran Hosp, Muroran, Hokkaido, Japan

[8] Japanese Red Cross Musashino Hosp, Musashino, Tokyo, Japan

[9] Shonan Kamakura Gen Hosp, Kamakura, Kanagawa, Japan

[10] Kagawa Univ Hosp, Miki, Kagawa, Japan

[11] Jichi Med Univ Hosp, Shimotsuke, Tochigi, Japan

[12] JA Hiroshima Gen Hosp, Hatsukaichi, Japan

[13] Japanese Red Cross Maebashi Hosp, Maebashi, Gumma, Japan

[14] Nara Med Univ, Kashihara, Nara, Japan

[15] Dokkyo Med Univ, Mibu, Tochigi, Japan

[16] Natl Hosp Org Tokyo Med Ctr, Tokyo, Japan

[17] Kurashiki Cent Hosp, Kurashiki, Okayama, Japan

[18] Hiroshima Univ, Hiroshima, Japan

[19] Wakayama Med Univ, Wakayama, Japan

[20] Hirosaki Univ Hosp, Hirosaki, Aomori, Japan

[21] Okinawa Chubu Hosp, Uruma, Japan

[22] Fujita Med Univ, Toyoake, Aichi, Japan

[23] Kyoto Med Ctr, Kyoto, Japan

[24] Tokyo Med & Dent Univ, Tokyo, Japan

[25] Shiga Univ Med Sci, Otsu, Shiga, Japan

[26] Aichi Med Univ, Nagakute, Aichi, Japan

[27] Nagasaki Univ, Nagasaki, Japan

[28] Shizuoka Prefectural Gen Hosp, Shizuoka, Japan

[29] Natl Hosp Org Nagoya Med Ctr, Nagoya, Aichi, Japan

[30] Yokohama City Minato Red Cross Hosp, Yokohama, Kanagawa, Japan

[31] Kyorin Univ, Mitaka, Tokyo, Japan

[32] Nippon Med Sch, Chiba Hokusoh Hosp, Tokyo, Japan

[33] Tottori Univ, Tottori, Japan

来源：

INTENSIVE CARE MEDICINE | 2020年 / 46卷 / 01期

关键词：

New-onset atrial fibrillation; Duration of atrial fibrillation; Critical illness; Mortality; Stroke; INTENSIVE-CARE-UNIT; MORTALITY; STROKE; TACHYARRHYTHMIAS; ARRHYTHMIAS; EVENTS;

D O I：

10.1007/s00134-019-05822-8

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

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.

引用

页码：27 / 35

页数：9

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