Kanjanahattakij Napatt, Rattanawong Pattara, Krishnamoorthy Parasuram, Horn Benjamin, Chongsathidkiet Pakawat, Garvia Veronica, Putthapiban Prapaipan, Sirinvaravong Natee, Figueredo Vincent M
a Department of Medicine , Einstein Medical Center , Philadelphia , PA, USA.
b University of Hawaii Internal Medicine Residency Program , Honolulu , HI, USA.
Acta Cardiol. 2019 Apr;74(2):162-169. doi: 10.1080/00015385.2018.1477035. Epub 2018 Jul 5.
Atrial fibrillation (AF) is one of the most comorbid conditions in critically ill patients requiring intensive care unit (ICU). Multiple studies have suggested that there may be an association between new-onset AF and adverse outcome in critically ill patients. However, there are no meta-analyses to assess this association.
Studies were systematically searched from electronic databases. Studies that examined the relationship between new-onset AF and adverse outcomes including mortality and length of stay in ICU patients were included. Studies that included patients with prior AF were excluded. The pooled effect size was calculated with a random-effect model, weighted for the inverse of variance, to determine an association between new-onset AF and in-hospital mortality. Heterogeneity was assessed with I.
Twelve studies were included. Pooled analysis showed statistically significant difference rate of the hospital mortality between patients with and without new-onset AF (OR 2.70; 95% CI 2.43-3.00). Subgroup analysis of only patients with sepsis or septic shock showed a significant association between new-onset AF and in-hospital mortality (OR 2.32; 95% CI 1.88-2.87). No significant heterogeneity was observed (I = 0%) in both analyses. Pooled analysis of four studies also showed a significant association between new-onset AF and short-term mortality (OR 2.22; 95% CI 1.28-3.83) with moderate heterogeneity (I = 67%).
New-onset AF is associated with worse outcome in critically ill patients. Further studies should be done to evaluate for causality and adjust for confounders.
心房颤动（AF）是需要重症监护病房（ICU）的危重症患者中最常见的合并症之一。多项研究表明，危重症患者新发房颤与不良预后之间可能存在关联。然而，尚无荟萃分析来评估这种关联。
从电子数据库中系统检索研究。纳入那些研究新发房颤与包括死亡率和ICU住院时间在内的不良结局之间关系的研究。排除纳入既往有房颤患者的研究。采用随机效应模型计算合并效应量，并以方差倒数加权，以确定新发房颤与院内死亡率之间的关联。用I²评估异质性。
纳入12项研究。汇总分析显示，新发房颤患者与未患新发房颤患者的医院死亡率差异有统计学意义（比值比2.70；95%置信区间2.43 - 3.00）。仅对脓毒症或脓毒性休克患者进行的亚组分析显示，新发房颤与院内死亡率之间存在显著关联（比值比2.32；95%置信区间1.88 - 2.87）。两项分析均未观察到显著异质性（I² = 0%）。对四项研究的汇总分析还显示，新发房颤与短期死亡率之间存在显著关联（比值比2.22；95%置信区间1.28 - 3.83）且具有中度异质性（I² = 67%）。
新发房颤与危重症患者的不良预后相关。应进一步开展研究以评估因果关系并对混杂因素进行校正。
