Service d'Anesthésie Réanimation 1, CHU Rennes, Hôpital Pontchaillou, Rennes, France.
Département d'Anesthésie Réanimation, CHU Angers, Angers, France.
J Intensive Care Med. 2019 Mar;34(3):238-244. doi: 10.1177/0885066617696847. Epub 2017 Mar 15.
Atrial fibrillation (AF) is common in the intensive care unit (ICU), notably in patients with septic shock for whom inflammation is an already identified risk factor. The aim of this study was to evaluate the effect of low-dose hydrocortisone on AF occurrence in patients with septic shock.
We performed a prospective nonrandomized observational study in 5 academic ICUs in France. From November 2012 to June 2014, all patients ≥16 years having septic shock were included, except those who had a history of AF, had a pacemaker, and/or experienced AF during hospitalization before the onset of shock or in whom the onset of shock occurred prior to admission to the ICU. Hydrocortisone was administered at the discretion of the attending physician. The incidence of AF was compared among patients who received hydrocortisone, and the effect of low-dose hydrocortisone on AF was estimated using the inverse probability treatment weighting method based on propensity scores.
A total of 261 patients were included (no-hydrocortisone group, n = 138; hydrocortisone group, n = 123). Atrial fibrillation occurred in 57 (22%) patients. Atrial fibrillation rates were 33 (24%) and 24 (19%) in no-hydrocortisone patients and hydrocortisone patients, respectively. In the weighted sample, the proportion of patients who developed AF was 28.8% in the no-hydrocortisone group and 16.8% in the hydrocortisone group (difference: -11.9%; 95% confidence interval: -23.4% to -0.5%; = .040).
In patients with septic shock, low-dose hydrocortisone was associated with a lower risk of developing AF during the acute phase.
心房颤动（AF）在重症监护病房（ICU）中很常见，特别是在患有脓毒性休克的患者中，炎症是已经确定的危险因素。本研究旨在评估小剂量氢化可的松对脓毒性休克患者 AF 发生的影响。
我们在法国的 5 个学术性 ICU 进行了一项前瞻性非随机观察性研究。从 2012 年 11 月至 2014 年 6 月，所有年龄≥16 岁的患有脓毒性休克的患者均被纳入研究，除外那些有 AF 病史、装有起搏器、在休克发生前住院期间发生过 AF 或在入住 ICU 前休克已经发生的患者。氢化可的松的使用由主治医生决定。比较接受和未接受氢化可的松治疗的患者中 AF 的发生率，并使用基于倾向评分的逆概率治疗加权法估计小剂量氢化可的松对 AF 的影响。
共纳入 261 例患者（未用氢化可的松组，n = 138；用氢化可的松组，n = 123）。57 例（22%）患者发生 AF。未用氢化可的松组和用氢化可的松组中分别有 33 例（24%）和 24 例（19%）患者发生 AF。在加权样本中，未用氢化可的松组和用氢化可的松组中分别有 28.8%和 16.8%的患者发生 AF（差异：-11.9%；95%置信区间：-23.4%至-0.5%；P =.040）。
在脓毒性休克患者中，小剂量氢化可的松与急性阶段发生 AF 的风险降低相关。
