Jamal Shakeel, Ijaz Sardar Hassan, Minhas Abdul Mannan Khan, Kichloo Asim, Khan Muhammad Zia, Albosta Michael, Aljadah Michael, Banga Sandeep, Baloch Zulfiqar Qutrio, Aboud Hussain, Haji Abdul Qadir, Sheikh Ali, Kanjwal Khalil
Department of Internal Medicine, Central Michigan University, Mount Pleasant, MI, USA.
Division of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA, USA.
Am J Med Sci. 2022 Sep;364(3):289-295. doi: 10.1016/j.amjms.2022.01.020. Epub 2022 Feb 6.
Acute respiratory distress syndrome (ARDS) is associated with high mortality. Atrial fibrillation (AF) is a common arrhythmia seen in critically ill patients. The impact of AF on the outcomes in patients with ARDS is less understood. In this analysis we attempt to evaluate the association of concurrent AF and various clinical outcomes in patients with ARDS.
We conducted a retrospective analysis of adult discharges from the National Inpatient Sample (NIS) between 2004 and 2014. International Classification of Disease codes were used to identify those with ARDS and AF.
We found 1,200,737 hospitalizations with ARDS, out of which 238,455 had concomitant diagnosis of AF. Hospitalizations with AF had higher prevalence of comorbidities including chronic pulmonary disease, diabetes mellitus, hypertension, obesity, congestive heart failure and renal failure. On adjusted analysis, AF was associated with increased odds of acute myocardial infarction, cardiogenic shock, pressor use, acute kidney injury, permanent pacemaker implantation, cardiac arrest, mechanical circulatory support use and higher length of stay and inflation-adjusted cost in hospitalizations with ARDS. However, there was no significant difference in adjusted all-cause mortality in ARDS with and without AF (25.42% vs 20.23%, p=0.53).
AF is associated with worse clinical outcomes, higher length of stay and cost in ARDS hospitalizations as compared to those without AF.
急性呼吸窘迫综合征（ARDS）与高死亡率相关。心房颤动（AF）是危重症患者中常见的心律失常。AF对ARDS患者预后的影响尚不清楚。在本分析中，我们试图评估ARDS患者并发AF与各种临床结局之间的关联。
我们对2004年至2014年间美国国家住院样本（NIS）中的成年出院患者进行了回顾性分析。使用国际疾病分类代码来识别患有ARDS和AF的患者。
我们发现1200737例ARDS住院患者，其中238455例同时诊断为AF。AF住院患者的合并症患病率更高，包括慢性肺病、糖尿病、高血压、肥胖、充血性心力衰竭和肾衰竭。经调整分析，AF与急性心肌梗死、心源性休克、使用升压药、急性肾损伤、永久性起搏器植入、心脏骤停、使用机械循环支持以及ARDS住院患者的住院时间延长和通胀调整后的费用增加的几率相关。然而，伴有和不伴有AF的ARDS患者经调整后的全因死亡率无显著差异（25.42%对20.23%，p = 0.53）。
与无AF的患者相比，AF与ARDS住院患者更差的临床结局、更长的住院时间和更高的费用相关。
