Champion Sébastien, Lefort Yannick, Gaüzère Bernard-Alex, Drouet Didier, Bouchet Bruno Julien, Bossard Guillaume, Djouhri Sabina, Vandroux David, Mayaram Kushal, Mégarbane Bruno
Service de réanimation polyvalente, CHU de la Réunion, hôpital Félix-Guyon, 97405 Saint-Denis, La Réunion, France; Réanimation Médicale et Toxicologique, Hôpital Lariboisière, Université Paris-Diderot, Paris, France.
Service de réanimation polyvalente, CHU de la Réunion, hôpital Félix-Guyon, 97405 Saint-Denis, La Réunion, France.
J Crit Care. 2014 Oct;29(5):854-8. doi: 10.1016/j.jcrc.2014.05.010. Epub 2014 May 28.
Prediction of arterial thromboembolic events (ATEs) in relation to supraventricular arrhythmia (SVA) has been poorly investigated in the intensive care unit (ICU). We aimed at evaluating CHADS2 and CHA2DS2-VASc scores to predict SVA-related ATE in the ICU.
We conducted a prospective observational study including all the patients except those in the postoperative course of cardiac surgery who presented SVA lasting 30 seconds or longer during their ICU stay. We looked for ATE during ICU stay, at the first and sixth month of follow-up after ICU discharge.
During the 15-month study period, 108 (12.8%) of 846 ICU patients experienced SVA with 12 SVA-related ATE occurring 6 days (3; 13) (median, 10%-90% percentiles) after SVA onset. In our SVA patients, CHADS2 score was 2 (0; 5), and CHA2DS2-VASc score 3 (0; 7). Both CHADS2 (odds ratio (OR), 1.6 [1.1; 2.4]; P = .01) and CHA2DS2-VASc scores (OR, 1.4 [1.04; 1.8]; P = .03) were significantly associated with ATE onset. However, the most accurate threshold for predicting ATE was CHADS2 score of 4 or higher. Using a multivariate analysis, only patient's history of stroke was associated with ATE onset (OR, 9.2 [2.4; 35]; P = .001).
CHADS2 and CHA2DS2-VASc scores are predictive of SVA-related thromboembolism in the critically ill patient.
在重症监护病房（ICU）中，关于室上性心律失常（SVA）相关的动脉血栓栓塞事件（ATEs）的预测研究较少。我们旨在评估CHADS2和CHA2DS2-VASc评分，以预测ICU中与SVA相关的ATE。
我们进行了一项前瞻性观察性研究，纳入了所有在ICU住院期间出现持续30秒或更长时间SVA的患者，但不包括心脏手术后处于术后病程的患者。我们在ICU住院期间以及ICU出院后的第一个月和第六个月随访时寻找ATE。
在15个月的研究期间，846例ICU患者中有108例（12.8%）发生了SVA，其中12例与SVA相关的ATE在SVA发作后6天（3；13）（中位数，第10%-90%百分位数）出现。在我们的SVA患者中，CHADS2评分为2（0；5），CHA2DS2-VASc评分为3（0；7）。CHADS2（比值比（OR），1.6 [1.1；2.4]；P = 0.01）和CHA2DS2-VASc评分（OR，1.4 [1.04；1.8]；P = 0.03）均与ATE发作显著相关。然而，预测ATE的最准确阈值是CHADS2评分为4或更高。使用多变量分析，只有患者的中风病史与ATE发作相关（OR，9.2 [2.4；35]；P = 0.001）。
CHADS2和CHA2DS2-VASc评分可预测危重症患者中与SVA相关的血栓栓塞。
