Rahimi Fatemeh Sadat, Afaghi Siamak, Tarki Farzad Esmaeili, Omran Hossein Salehi, Nasirpour Mohammad Hossein
Department of Surgery, Clinical Research and Development Center, Shahid Modarres Hospital Shahid Beheshti University of Medical Sciences Tehran Iran.
Research Institute of Internal Medicine, Shahid Modarres Hospital Shahid Beheshti University of Medical Sciences Tehran Iran.
Health Sci Rep. 2022 Oct 17;5(6):e813. doi: 10.1002/hsr2.813. eCollection 2022 Nov.
We focused on determining the risk factors, thromboembolic events, and clinical course of New-Onset Atrial Fibrillation (NOAF) among hospitalized coronavirus disease (COVID-19) patients.
This retrospective study was conducted in the major referral centers in Tehran, Iran. Of 1764 patients enrolled in the study from January 2020 until July 2021, 147 had NOAF, and 1617 had normal sinus rhythm. Univariate and multivariate Logistic regressions were employed accordingly to evaluate NOAF risk factors. The statistical assessments have been run utilizing SPSS 25.0 (SPSS) or R 3.6.3 software.
For the NOAF patients, the age was significantly higher, and the more prevalent comorbidities were metabolic syndrome, heart failure (HF), peripheral vascular disease, coronary artery disease, and liver cirrhosis. The multivariate analysis showed the established independent risk factors were; Troponin-I (hazard ratio [HR] = 3.86; 95% confidence interval [CI] = 1.89-7.87; < 0.001), HF (HR = 2.54; 95% CI = 1.61-4.02; < 0.001), bilateral grand-glass opacification (HR = 2.26; 95% CI = 1.68-3.05; = 0.002). For cases with thromboembolic events, NOAF was the most important prognostic factor (odds ratio [OR] = 2.97; 95% CI = 2.03-4.33; < 0.001). While evaluating the diagnostic ability of prognostic factors in detecting NOAF, Troponin-I (Area under the curve [AUC] = 0.85), C-Reactive Protein (AUC = 0.72), and d-dimer (AUC = 0.65) had the most accurate sensitivity. Furthermore, the Kaplan-Meier curves demonstrated that the survival rates diminished more steeply for patients with NOAF history.
In hospitalized COVID-19 patients with NOAF, the risk of thromboembolic events, hospital stay, and fatality are significantly higher. The established risk factors showed that patients with older age, higher inflammation states, and more severe clinical conditions based on CHADS2VASC-score potentially need subsequent preventive strategies. Appropriate prophylactic anticoagulants, Initial management of cytokine storm, sufficient oxygen support, and reducing viral shedding could be of assistance in such patients.
我们专注于确定住院的冠状病毒病（COVID-19）患者中新发房颤（NOAF）的危险因素、血栓栓塞事件及临床病程。
这项回顾性研究在伊朗德黑兰的主要转诊中心进行。在2020年1月至2021年7月纳入研究的1764例患者中，147例患有NOAF，1617例为正常窦性心律。相应地采用单因素和多因素逻辑回归来评估NOAF的危险因素。使用SPSS 25.0（SPSS）或R 3.6.3软件进行统计评估。
对于NOAF患者，年龄显著更高，更常见的合并症是代谢综合征、心力衰竭（HF）、外周血管疾病、冠状动脉疾病和肝硬化。多因素分析显示确定的独立危险因素为：肌钙蛋白I（风险比[HR]=3.86；95%置信区间[CI]=1.89 - 7.87；<0.001）、HF（HR = 2.54；95% CI = 1.61 - 4.02；<0.001）、双侧磨玻璃影（HR = 2.26；95% CI = 1.68 - 3.05；=0.002）。对于有血栓栓塞事件的病例，NOAF是最重要的预后因素（优势比[OR]=2.97；95% CI = 2.03 - 4.33；<0.001）。在评估预后因素检测NOAF的诊断能力时，肌钙蛋白I（曲线下面积[AUC]=0.85）、C反应蛋白（AUC = 0.72）和D - 二聚体（AUC = 0.65）具有最准确的敏感性。此外，Kaplan - Meier曲线表明有NOAF病史的患者生存率下降更为陡峭。
在住院的COVID - 19合并NOAF患者中，血栓栓塞事件、住院时间和死亡风险显著更高。已确定的危险因素表明，年龄较大、炎症状态较高以及基于CHADS2VASC评分临床状况更严重的患者可能需要后续的预防策略。适当的预防性抗凝剂、细胞因子风暴的初始管理、充足的氧支持以及减少病毒脱落可能对这类患者有帮助。
