Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; University of Sydney, New South Wales, Australia.
Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Oxford Critical Care, Oxford University Hospitals NHS Foundation Trust, UK.
J Crit Care. 2022 Dec;72:154161. doi: 10.1016/j.jcrc.2022.154161. Epub 2022 Oct 7.
We performed a systematic review and meta-analysis to investigate the long-term outcomes of patients who develop new-onset atrial fibrillation (NOAF) during an intensive care unit (ICU) admission.
We searched the MEDLINE and EMBASE databases from 2000 to 2022. We included studies of adults based in general ICUs that evaluated long-term outcomes (at least 30 days after hospital discharge) of NOAF. We excluded studies involving patients with a history of atrial fibrillation (AF). We performed risk of bias assessment of the included studies based on a modified Newcastle Ottawa score (NOS). We extracted summary data for long-term outcomes. Where the outcome was reported in three or more studies we pooled effect sizes.
We screened 2206 studies and included 15 studies reporting data from 561,797 patients. Pooled analysis of 4 studies using a random effects model revealed an association between NOAF acquired in an ICU and 90-day mortality (including ICU and hospital mortality) (RR 1.53, 95% CI 1.12-2.08). We also found an association between NOAF and 1-year mortality from 7 studies (RR 1.79, 95% CI 1.65-1.96), which remained when analysing 1-year mortality in hospital survivors (RR 1.72 (95% CI 1.49-1.98).
In patients who develop NOAF in an ICU, both 90-day and 1-year mortality are increased in comparison to those who do not develop NOAF. Current evidence suggests an increased risk of thromboembolic events after hospital discharge in patients who develop NOAF in an ICU.
我们进行了一项系统回顾和荟萃分析，旨在调查在重症监护病房（ICU）住院期间发生新发心房颤动（NOAF）的患者的长期结局。
我们检索了 2000 年至 2022 年期间的 MEDLINE 和 EMBASE 数据库。我们纳入了基于普通 ICU 的评估 NOAF 患者长期结局（至少在出院后 30 天）的成人研究。我们排除了有房颤（AF）病史的患者。我们根据改良的纽卡斯尔-渥太华评分（NOS）对纳入的研究进行了偏倚风险评估。我们提取了长期结局的汇总数据。对于报告了三个或更多研究的结局，我们对效应大小进行了汇总。
我们筛选了 2206 项研究，纳入了 15 项研究，共纳入了 561797 名患者的数据。四项研究的汇总分析结果显示，ICU 获得的 NOAF 与 90 天死亡率（包括 ICU 和医院死亡率）相关（RR 1.53，95%CI 1.12-2.08）。我们还发现 7 项研究中 NOAF 与 1 年死亡率之间存在相关性（RR 1.79，95%CI 1.65-1.96），在分析医院幸存者 1 年死亡率时仍存在相关性（RR 1.72（95%CI 1.49-1.98）。
与未发生 NOAF 的患者相比，在 ICU 中发生 NOAF 的患者，90 天和 1 年死亡率均增加。目前的证据表明，在 ICU 中发生 NOAF 的患者出院后发生血栓栓塞事件的风险增加。
