危重症患者新发心房颤动及其与死亡率的关系：来自 FROG-ICU 研究的报告。

New-onset atrial fibrillation in critically ill patients and its association with mortality: A report from the FROG-ICU study.

机构信息

Department of Anaesthesiology and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals and INSERM UMR-S 942, Paris, France; Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.

Department of Anaesthesiology and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals and INSERM UMR-S 942, Paris, France.

出版信息

Int J Cardiol. 2018 Sep 1;266:95-99. doi: 10.1016/j.ijcard.2018.03.051.

DOI:10.1016/j.ijcard.2018.03.051

PMID:29887481

Abstract

BACKGROUND

Atrial fibrillation (AFib) is associated with adverse outcome in critical illness, but whether this effect is independent from other risk factors remains uncertain. New-onset AFib during critical illness may be independently associated with increased in-hospital and long-term risk of death.

METHODS

FROG-ICU was a prospective, observational, multi-centre cohort study designed to investigate the outcome of critically ill patients. Inclusion criteria were invasive mechanical ventilation and/or treatment with a positive inotropic agent for >24 h. Heart rhythm was assessed at inclusion and during ICU stay with digital ECG recordings. Among patients who had AFib during ICU stay, new-onset and recurrent AFib were diagnosed in patients without and with previous history of AFib, respectively. Primary endpoint was in-hospital mortality; secondary endpoint was 1-year mortality among ICU survivors.

RESULTS

The study included 1841 critically ill patients. During ICU stay, AFib occurred in 343 patients (19%). New-onset AFib (n = 212) had higher in-hospital mortality compared to no AFib (47 vs. 23%, P < 0.001) or recurrent AFib (34%, P = 0.032). New-onset AFib showed increased risk of in-hospital death after multivariable adjustment compared to no AFib (OR 1.6, P = 0.003) or recurrent AFib (OR 1.8, P = 0.02). Among the 1464 ICU-survivors, new-onset AFib during ICU stay showed higher post-ICU risk of death compared to no AFib (HR 2.2, P < 0.001). After multivariable adjustment, new-onset AFib showed higher post-ICU risk of death compared to no AFib (HR 1.6, P = 0.03).

CONCLUSION

New-onset AFib is independently associated with in-hospital and post-ICU risk of death in critically ill patients.

摘要

背景

心房颤动（房颤）与危重病患者的不良预后相关，但这种影响是否独立于其他危险因素尚不确定。危重病期间新发房颤可能与住院期间和长期死亡风险增加独立相关。

方法

FROG-ICU 是一项前瞻性、观察性、多中心队列研究，旨在研究危重病患者的结局。纳入标准为接受有创机械通气和/或正性肌力药物治疗>24 小时。在纳入时和 ICU 期间使用数字心电图记录评估心律。在 ICU 期间发生房颤的患者中，新发和复发性房颤分别在无和有房颤病史的患者中诊断。主要终点为住院死亡率；次要终点为 ICU 幸存者 1 年死亡率。

结果

研究纳入了 1841 例危重病患者。在 ICU 期间，343 例（19%）患者发生房颤。与无房颤（47% vs. 23%，P<0.001）或复发性房颤（34%，P=0.032）相比，新发房颤患者住院死亡率更高。多变量调整后，与无房颤（OR 1.6，P=0.003）或复发性房颤（OR 1.8，P=0.02）相比，新发房颤患者住院死亡风险增加。在 1464 例 ICU 幸存者中，与无房颤相比，ICU 期间新发房颤患者 ICU 后死亡风险更高（HR 2.2，P<0.001）。多变量调整后，与无房颤相比，新发房颤患者 ICU 后死亡风险更高（HR 1.6，P=0.03）。