Kidney Center, Turku University Hospital and University of Turku, Hämeentie 11, PO Box 52, Turku 20521, Finland.
Department of Anaesthesiology and Intensive Care, Turku University Hospital and University of Turku, Hämeentie 11, PO Box 52, Turku 20521, Finland.
Europace. 2022 Feb 2;24(2):211-217. doi: 10.1093/europace/euab163.
The effect of new-onset atrial fibrillation (NOAF) on mortality in critically ill patients with acute kidney injury (AKI) treated in the intensive care unit (ICU) requiring continuous veno-venous haemodialysis (CVVHD) or intermittent haemodialysis (IHD) is unknown. Thus, we examined the incidence of NOAF in critically ill AKI patients undergoing CVVHD or IHD and the association between the timing of NOAF incidence in relation to renal replacement therapy (RRT) initiation and 1-year mortality.
Out of the 733 consecutively recruited ICU patients requiring RRT within the study period of 2010-2019, 516 patients without prior atrial fibrillation history were included in this retrospective study. Clinical comorbidities, medications and biochemistry as well as outcome data for 1-year all-cause mortality were recorded. Episodes of NOAF were collected from the pooled rhythm data covering the entire ICU stay of every patient. The median age was 64 (inter-quartile range 19) years, 165 (32%) were female, and 356 and 160 patients received CVVHD and IHD, respectively. NOAF was observed in 190 (37%) patients during ICU care and 217 (42%) patients died within the 1-year follow-up. Incident NOAF was independently associated with 1-year mortality in the multivariable logistic regression analysis after adjusting for dialysis modality, need for mechanical ventilation or vasopressor support and Acute Physiology And Chronic Health Evaluation II score. However, NOAF diagnosed after RRT initiation was not associated with mortality.
NOAF emerging before RRT initiation is associated with increased mortality in critically ill AKI patients requiring RRT. However, NOAF during RRT does not seem to be associated with mortality.
在重症监护病房（ICU）接受连续静脉-静脉血液透析（CVVHD）或间歇性血液透析（IHD）治疗的急性肾损伤（AKI）危重症患者中，新发心房颤动（NOAF）对死亡率的影响尚不清楚。因此，我们检查了接受 CVVHD 或 IHD 的危重症 AKI 患者中 NOAF 的发生率，以及 NOAF 发生与肾脏替代治疗（RRT）启动时间之间的关系与 1 年死亡率。
在 2010 年至 2019 年期间，连续招募了 733 名需要 RRT 的 ICU 患者，其中 516 名无既往心房颤动史的患者被纳入本回顾性研究。记录了临床合并症、药物和生物化学以及 1 年全因死亡率的结果数据。从每位患者整个 ICU 住院期间的汇总节律数据中收集了 NOAF 发作。中位年龄为 64 岁（四分位距 19 岁），165 例（32%）为女性，356 例和 160 例分别接受了 CVVHD 和 IHD。190 例（37%）患者在 ICU 护理期间发生了 NOAF，217 例（42%）患者在 1 年随访期间死亡。在多变量逻辑回归分析中，调整透析方式、机械通气或血管加压支持的需要以及急性生理学和慢性健康评估 II 评分后，新发的 NOAF 与 1 年死亡率独立相关。然而，RRT 启动后诊断的 NOAF 与死亡率无关。
在需要 RRT 的危重症 AKI 患者中，RRT 启动前出现的 NOAF 与死亡率增加相关。然而，RRT 期间的 NOAF 似乎与死亡率无关。
