Department of Medicine, North Shore Medical Center, Salem, MA, United States; Department of Medicine, Tufts University Medical School, Boston, MA, United States; School of Public Health, University of Massachusetts Lowell, Lowell, MA, United States.
School of Public Health, University of Massachusetts Lowell, Lowell, MA, United States.
Heart Lung. 2020 Jan-Feb;49(1):73-79. doi: 10.1016/j.hrtlng.2019.07.002. Epub 2019 Jul 16.
Cirrhotic cardiomyopathy, hyperammonemia, and hepatorenal syndrome predispose to cardiac arrhythmias in End-stage liver disease (ESLD).
Among ESLD hospitalizations, we evaluate the distribution and predictors of arrhythmias and their impact on hospitalization outcomes.
We selected ESLD records from the Nationwide Inpatient Sample (2007-2014), identified concomitant arrhythmias (tachyarrhythmias and bradyarrhythmias), and their demographic and comorbid characteristics, and estimated the effect of arrhythmia on outcomes (SAS 9.4).
Of 57,119 ESLD hospitalizations, 6,615 had arrhythmias with higher odds with increasing age, males, jaundice, hepatorenal syndrome, alcohol use, and cardiopulmonary disorders. The most common arrhythmias were atrial fibrillation, cardiac arrest/asystole, and ventricular tachycardia. After propensity-matching (arrhythmia: no-arrhythmia, 6,609:6,609), arrhythmias were associated with 200% higher mortality, 1.7-days longer stay, $32,880 higher cost, and higher rates of shock, respiratory and kidney failures.
Due to worse outcomes with arrhythmias, there is a need for better screening and follow-up of ESLD patients for dysrhythmias.
肝硬化性心肌病、高血氨和肝肾综合征使终末期肝病（ESLD）患者易发生心律失常。
我们评估了 ESLD 住院患者心律失常的分布和预测因素及其对住院结局的影响。
我们从全美住院患者样本（2007-2014 年）中选择了 ESLD 记录，确定了并存的心律失常（快速性和缓慢性心律失常）及其人口统计学和合并症特征，并估计了心律失常对结局的影响（SAS 9.4）。
在 57119 例 ESLD 住院患者中，有 6615 例患者发生心律失常，年龄越大、男性、黄疸、肝肾综合征、酒精使用和心肺疾病的发生率越高。最常见的心律失常是心房颤动、心脏骤停/心搏停止和室性心动过速。在倾向评分匹配（心律失常：无心律失常，6609：6609）后，心律失常与死亡率增加 200%、住院时间延长 1.7 天、费用增加 32880 美元以及休克、呼吸和肾功能衰竭的发生率更高相关。
由于心律失常的预后较差，因此需要对 ESLD 患者进行更好的心律失常筛查和随访。
