Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
Department of Cardiology, The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
BMJ Open. 2023 Jan 2;13(1):e069333. doi: 10.1136/bmjopen-2022-069333.
To find out the effect of different oral anticoagulation therapies (OAC) on mortality rate in patients with acute kidney injury (AKI) and atrial fibrillation (AF).A retrospective study.
This study was conducted in the Medical Information Mart for Intensive Care IV database.
A total of 19 672 patients diagnosed with AKI.
Patients were categorised into three groups: (1) AF; (2) AKI and AF, OAC-; (3) AKI and AF, OAC+. The primary endpoint was 30-day mortality. Secondary endpoints were the length of stay (LOS) in the intensive care unit (ICU) and hospital. Propensity score matching (PSM) and Cox proportional hazards model adjusted confounding factors. Linear regression was applied to assess the associations between OAC treatment and LOS.
After PSM, 2042 pairs of AKI and AF patients were matched between the patients who received OAC and those without anticoagulant treatment. Cox regression analysis showed that, OAC significantly reduce 30-day mortality compared with non-OAC (HR 0.30; 95% CI 0.25 to 0.35; p<0.001). Linear regression analysis revealed that OAC prolong LOS in hospital (11.3 days vs 10.0 days; p=0.013) and ICU (4.9 days vs 4.4 days; p<0.001). OAC did not improve survival in patients with haemorrhage (HR 0.67; 95% CI 0.34 to 1.29; p=0.23). Novel OAC did not reduce mortality in acute-on-chronic renal injury (HR 2.03; 95% CI 1.09 to 3.78; p=0.025) patients compared with warfarin.
OAC administration was associated with improved short-term survival in AKI patients concomitant with AF.
探讨不同口服抗凝治疗（OAC）对急性肾损伤（AKI）合并心房颤动（AF）患者死亡率的影响。这是一项回顾性研究。
本研究在重症监护 IV 医学信息集市数据库中进行。
共纳入 19672 例 AKI 患者。
患者分为三组：（1）AF；（2）AKI 合并 AF，OAC-；（3）AKI 合并 AF，OAC+。主要终点为 30 天死亡率。次要终点为 ICU 和住院时间。采用倾向性评分匹配（PSM）和 Cox 比例风险模型调整混杂因素。线性回归用于评估 OAC 治疗与 LOS 之间的关系。
PSM 后，接受 OAC 治疗与未接受抗凝治疗的 AKI 和 AF 患者有 2042 对匹配。Cox 回归分析显示，与非 OAC 组相比，OAC 显著降低 30 天死亡率（HR 0.30；95%CI 0.25 至 0.35；p<0.001）。线性回归分析显示，OAC 延长了住院时间（11.3 天比 10.0 天；p=0.013）和 ICU 时间（4.9 天比 4.4 天；p<0.001）。OAC 对出血患者的生存没有改善（HR 0.67；95%CI 0.34 至 1.29；p=0.23）。与华法林相比，新型 OAC 并未降低慢性肾损伤急性加重患者的死亡率（HR 2.03；95%CI 1.09 至 3.78；p=0.025）。
在 AKI 合并 AF 患者中，OAC 治疗与短期生存率的提高相关。
