Wayne State University, Department of Cardiology, Detroit, Michigan.
Wayne State University, Department of Cardiology, Detroit, Michigan.
Am J Cardiol. 2019 Oct 1;124(7):1056-1058. doi: 10.1016/j.amjcard.2019.07.004. Epub 2019 Jul 22.
Alcohol withdrawal syndrome (AWS) has been associated with significant medical complications and length of stay. Cardiovascular effects from AWS include a physiologic tachycardia and hypertensive response. Although atrial fibrillation (AF) is one of the most common arrhythmias, the impact of a known history of AF on AWS is unclear. The purpose of our study is to assess the impact of history of AF on clinical outcomes, cost, and length of stay on AWS. The Nationwide Inpatient Sample was used to identify patients aged 18 years or older who underwent AWS with or without AF using the International Classification of Disease 9 Clinical Modification codes from January 2010 to December 2014. Outcomes were compared between those with or without AF using propensity score method-stratified morbidity ratio weighing- to adjust for baseline patient and hospital characteristics. A total of 280,451 patients with AWS of which 14,459 (5.2%) had history of AF. Patients with AF was older, less likely female, and more had higher burden of co-morbidities. In an adjusted model, in-hospital mortality (odds ratio [OR] 1.98 95% confidence interval [CI] 1.61 to 2.45), ischemic stroke (OR 1.67 95% CI 1.42 to 1.95), acute kidney injury (OR 1.36 95% CI 1.24 to 1.49), acute kidney injury requiring dialysis (OR 1.89 95% CI 1.39 to 2.50), and cost (mean ratio 1.27 95% CI 1.21 to 1.33) were higher in the AF cohort. Length of stay was shorter in patients with AF (mean ratio 0.85 95% CI 0.81 to 0.90). In conclusion, a known history of AF increased the risk of in-hospital mortality, morbidity, and hospital expense in AWS.
酒精戒断综合征（AWS）与重大的医疗并发症和住院时间延长有关。AWS 的心血管效应包括生理性心动过速和高血压反应。尽管心房颤动（AF）是最常见的心律失常之一，但已知的 AF 病史对 AWS 的影响尚不清楚。我们的研究目的是评估 AF 病史对 AWS 的临床结局、成本和住院时间的影响。使用国际疾病分类第 9 次临床修订版（ICD-9-CM）代码，从 2010 年 1 月至 2014 年 12 月，从全国住院患者样本中确定了年龄在 18 岁或以上的接受 AWS 治疗的患者，无论是否有 AF。使用倾向评分法-分层发病率比加权法比较有无 AF 的患者之间的结局，以调整基线患者和医院特征。共纳入 280451 例 AWS 患者，其中 14459 例（5.2%）有 AF 病史。有 AF 病史的患者年龄较大，女性较少，合并症负担较重。在调整后的模型中，院内死亡率（比值比[OR] 1.98，95%置信区间[CI] 1.61 至 2.45）、缺血性脑卒中（OR 1.67，95%CI 1.42 至 1.95）、急性肾损伤（OR 1.36，95%CI 1.24 至 1.49）、需要透析的急性肾损伤（OR 1.89，95%CI 1.39 至 2.50）和费用（平均比值 1.27，95%CI 1.21 至 1.33）在 AF 组更高。AF 患者的住院时间更短（平均比值 0.85，95%CI 0.81 至 0.90）。总之，已知的 AF 病史增加了 AWS 患者住院期间死亡、发病和住院费用的风险。
