新型冠状病毒肺炎患者的新发房颤与院内死亡率
Incident Atrial Fibrillation and In-Hospital Mortality in SARS-CoV-2 Patients.
作者信息
Maloberti Alessandro, Giannattasio Cristina, Rebora Paola, Occhino Giuseppe, Ughi Nicola, Biolcati Marco, Gualini Elena, Rizzi Jacopo Giulio, Algeri Michela, Giani Valentina, Rossetti Claudio, Epis Oscar Massimiliano, Molon Giulio, Beltrame Anna, Bonfanti Paolo, Valsecchi Maria Grazia, Genovesi Simonetta
机构信息
Cardiology 4, "A. De Gasperis" Cardio Center, ASST GOM Niguarda Ca' Granda, 20162 Milan, Italy.
School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy.
出版信息
Biomedicines. 2022 Aug 10;10(8):1940. doi: 10.3390/biomedicines10081940.
(1) Background: Among the different cardiovascular (CV) manifestations of the coronavirus disease 2019 (COVID-19), arrhythmia and atrial fibrillation (AF) in particular have recently received special attention. The aims of our study were to estimate the incidence of AF in patients hospitalized for COVID-19, and to evaluate its role as a possible predictor of in-hospital all-cause mortality. (2) Methods: We enrolled 3435 people with SARS-CoV2 infection admitted to three hospitals in Northern Italy from February 2020 to May 2021. We collected data on their clinical history, laboratory tests, pharmacological treatment and intensive care unit (ICU) admission. Incident AF and all-cause in-hospital mortality were considered as outcomes. (3) Results: 145 (4.2%) patients developed AF during hospitalization, with a median time since admission of 3 days (I-III quartile: 0, 12). Patients with incident AF were admitted more frequently to the ICU (39.3 vs. 12.4%, p < 0.001), and more frequently died (37.2 vs. 16.9%, p < 0.001). In the Cox regression model, the significant determinants of incident AF were age (HR: 1.041; 95% CI: 1.022, 1.060 per year), a history of AF (HR: 2.720; 95% CI: 1.508, 4.907), lymphocyte count (HR: 0.584; 95% CI: 0.384, 0.888 per 103/µL), estimated glomerular filtration rate (eGFR, HR: 0.988; 95% CI: 0.980, 0.996 per mL/min) and ICU admission (HR: 5.311; 95% CI: 3.397, 8.302). Incident AF was a predictor of all-cause mortality (HR: 1.405; 95% CI: 1.027, 1.992) along with age (HR: 1.057; 95% CI: 1.047, 1.067), male gender (HR: 1.315; 95% CI: 1.064; 1.626), dementia (HR: 1.373; 95% CI: 1.045, 1.803), lower platelet (HR: 0.997; 95% CI: 0.996, 0.998 per 103/µL) and lymphocyte counts (HR: 0.843; 95% CI: 0.725, 0.982 per 103/µL), C-Reactive protein values (HR: 1.004; 95% CI: 1.003, 1.005 per mg/L), eGFR (HR: 0.990; 95% CI: 0.986, 0.994 per mL/min), and ICU admission (HR: 1.759; 95% CI: 1.292, 2.395). (4) Conclusions: Incident AF is a common complication in COVID-19 patients during hospitalization, and its occurrence strongly predicts in-hospital mortality.
（1）背景：在2019冠状病毒病（COVID - 19）的不同心血管（CV）表现中，心律失常尤其是心房颤动（AF）最近受到了特别关注。我们研究的目的是估计因COVID - 19住院患者中AF的发生率，并评估其作为院内全因死亡率可能预测指标的作用。（2）方法：我们纳入了2020年2月至2021年5月期间在意大利北部三家医院收治的3435例感染严重急性呼吸综合征冠状病毒2（SARS-CoV2）的患者。我们收集了他们的临床病史、实验室检查、药物治疗和重症监护病房（ICU）入住情况的数据。将新发AF和院内全因死亡率视为研究结果。（3）结果：145例（4.2%）患者在住院期间发生AF，自入院起的中位时间为3天（第一至第三四分位数：0，12）。新发AF患者更频繁地入住ICU（39.3%对12.4%，p<0.001），且死亡更频繁（37.2%对16.9%，p<0.001）。在Cox回归模型中，新发AF的显著决定因素包括年龄（HR：1.041；95%CI：1.022，1.060/年）、AF病史（HR：2.720；95%CI：1.508，4.907）、淋巴细胞计数（HR：0.584；95%CI：0.384，0.888/10³/µL）、估计肾小球滤过率（eGFR，HR：0.988；95%CI：0.980，0.996/mL/min）和入住ICU（HR：5.311；95%CI：3.397，8.302）。新发AF与年龄（HR：1.057；95%CI：1.047，1.067）、男性（HR：1.315；95%CI：1.064；1.626）、痴呆（HR：1.373；95%CI：1.045，1.803）、较低的血小板（HR：0.997；95%CI：0.996，0.998/10³/µL）和淋巴细胞计数（HR：0.843；95%CI：0.725，0.982/10³/µL）、C反应蛋白值（HR：1.004；95%CI：1.003，1.005/mg/L）、eGFR（HR：0.990；95%CI：0.986，0.994/mL/min）以及入住ICU（HR：1.759；95%CI：1.292，2.395）一样，是全因死亡率的预测指标。（4）结论：新发AF是COVID - 19患者住院期间的常见并发症，其发生强烈预示院内死亡率。
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