Mahfouz Ratib, Douglas Mustafa F, Obeidat Adham E, Darweesh Mohammad, Mansour Mahmoud M, Shah Parthav, Aldiabat Mohammad, Aljabiri Yazan, Fishman Angela
Internal Medicine, Kent Hospital/Brown University, Warwick, USA.
Internal Medicine, Midwestern University Arizona College of Osteopathic Medicine, Sierra Vista, USA.
Cureus. 2022 Aug 10;14(8):e27849. doi: 10.7759/cureus.27849. eCollection 2022 Aug.
Introduction Inflammatory bowel disease (IBD) is a chronic, relapsing, inflammatory disorder of the gastrointestinal tract. Patients with IBD may undergo a segmental or total colectomy, depending upon the extent of the disease. It is estimated that approximately 20 to 30 percent of patients with advanced ulcerative colitis will eventually require surgical resection. The incidence and prevalence of Atrial Fibrillation (AF) are increasing globally. There is plausible evidence linking inflammation to the initiation and perpetuation of AF. Given the importance of systemic inflammation in the pathogenesis of AF, an increased risk of the development of other diseases related to systemic inflammation can be expected. Objective Study how AF can affect the outcome of the patients in a population database hospitalized due to IBD flare and in whom colectomy was performed. Methodology Data from the National Inpatient Sample database from 2016 to 2019 were used to obtain baseline demographic numbers and outcome variables. T-tests and chi-square tests were used to compare data. Univariate and multivariate logistic regression was used to calculate Odds ratios for comorbidities. Results The study identified 27,165 patients with IBD who had colectomy during the same admission, among whom 2,045 also had AF. AF patients had a statistically significant longer mean LOS than patients without AF (16.79 vs. 11.24 days, p-value 0.001). AF patients also had significantly higher hospital charges ($222,109 vs. $142,011, p-value < 0.001). The mortality rate in IBD undergoing colectomy patients with AF was higher than in patients without AF (13.45% vs. 2.69%, p-value < 0.001), which was also reflected in multivariate analysis with an odds ratio of 2.27 (p-value < 0.001) after adjusting for age, gender, race, and comorbidities. Conclusion Our study showed that a national cohort of IBD patients with a history of colectomy had increased mortality and morbidity in the presence of AF. A finding that can guide physicians to allocate more time to optimizing the management of AF in this group of patients decreases the risk of complications, length of stay, and overall mortality.
引言 炎症性肠病（IBD）是一种胃肠道的慢性、复发性炎症性疾病。IBD患者可能会根据疾病的程度接受节段性或全结肠切除术。据估计，约20%至30%的重度溃疡性结肠炎患者最终需要手术切除。全球范围内，心房颤动（AF）的发病率和患病率都在上升。有合理的证据表明炎症与AF的发生和持续存在有关。鉴于全身炎症在AF发病机制中的重要性，可以预期与全身炎症相关的其他疾病的发生风险会增加。目的 研究在因IBD发作住院并接受结肠切除术的人群数据库中，AF如何影响患者的预后。方法 使用2016年至2019年国家住院患者样本数据库的数据来获取基线人口统计学数据和结局变量。采用t检验和卡方检验来比较数据。单因素和多因素逻辑回归用于计算合并症的比值比。结果 该研究确定了27165例在同一住院期间接受结肠切除术的IBD患者，其中2045例也患有AF。AF患者的平均住院时间在统计学上显著长于无AF患者（16.79天对11.24天，p值为0.001）。AF患者的住院费用也显著更高（222109美元对142011美元，p值<0.001）。接受结肠切除术的IBD患者中，AF患者的死亡率高于无AF患者（13.45%对2.69%，p值<0.001），在调整年龄、性别、种族和合并症后，多因素分析中这一情况也有所体现，比值比为2.27（p值<0.001）。结论 我们的研究表明，有结肠切除病史的全国队列IBD患者在患有AF时死亡率和发病率会增加。这一发现可以指导医生为优化该组患者的AF管理分配更多时间，以降低并发症风险、缩短住院时间和降低总体死亡率。
