Internal Medicine, Wayne State University, St Antoine street, Detroit, MI 48201, USA.
Internal Medicine, Baptist Health System, 400 Taylor Road Montgomery, AL 36117, USA.
Europace. 2023 Apr 15;25(4):1408-1414. doi: 10.1093/europace/euad004.
Literature regarding outcomes associated with atrial fibrillation among cirrhosis patients who had left atrial appendage occlusion (LAAO) device procedure is limited. We aim to evaluate the in-hospital clinical outcomes and 30-day readmissions among LAAO with and without cirrhosis.
We performed a retrospective study of all hospitalizations associated with the LAAO procedure, using the Nationwide Readmissions Database for the years 2016-19. Primary outcomes were in-hospital clinical outcomes and 30-day readmissions. A total of 54 897 index hospitalizations for LAAO (female 41.8%) were reported. Of these, 905(1.65%) had cirrhosis. Gastrointestinal (GI) bleeding was reported in 44 (4.9%) vs. 1606 (2.97%) and coagulopathy in 21 (2.3%) vs. 521 (0.96%) in cirrhosis and without-cirrhosis groups, respectively. A total of 872 (1.59%) patients needed blood transfusion, 24 (2.7%) vs. 848(1.57%) in cirrhosis vs. without-cirrhosis groups (P = 0.047). Fresh frozen plasma (FFP) transfusion was reported among 888 (1.62%), with cirrhosis 26 (3%) vs. without cirrhosis 862 (1.6%) (P = 0.05). On adjusted multivariate logistic regression analysis, acute kidney injury, coagulopathy, FFP transfusion, and blood transfusion were strongly associated with cirrhosis, and GI bleeding, ischaemic stroke, and intracranial haemorrhage were not associated with cirrhosis. Readmissions in 30 days were 5028 (9.18%), 167 (18.5%) in the cirrhosis group and 4861 (9%) without-cirrhosis group (P = 0.01). On multivariate Cox regression, CHA2DS2-Vasc score of six was significantly associated with 30-day readmission compared with other scores [hazard ratio 2.24; 95% confidence interval (1.58-3.16); P < 0.001].
Left atrial appendage occlusion procedure in patients with cirrhosis had relatively similar GI bleeding and stroke rates, however, had higher rates of 30-day readmission. A higher CHA2DS2-Vasc score was more likely to be associated with 30-day readmissions and hence would help in discharge planning. The long-term safety and efficacy of LAAO in the cirrhosis population need to be demonstrated.
有关接受左心耳封堵术（LAAO）的肝硬化患者的房颤相关结局的文献有限。我们旨在评估 LAAO 合并和不合并肝硬化患者的住院临床结局和 30 天再入院率。
我们使用 2016 年至 2019 年全国再入院数据库，对所有与 LAAO 手术相关的住院治疗进行了回顾性研究。主要结局为住院期间的临床结局和 30 天再入院率。共报告了 54897 例 LAAO 指数住院治疗（女性占 41.8%）。其中，905 例（1.65%）有肝硬化。肝硬化组和无肝硬化组分别有 44 例（4.9%）和 1606 例（2.97%）出现胃肠道（GI）出血，21 例（2.3%）和 521 例（0.96%）出现凝血障碍。共有 872 例（1.59%）患者需要输血，肝硬化组 24 例（2.7%），无肝硬化组 848 例（1.57%）（P=0.047）。报告有 888 例（1.62%）患者输注新鲜冰冻血浆（FFP），肝硬化组 26 例（3%），无肝硬化组 862 例（1.6%）（P=0.05）。在调整后的多变量逻辑回归分析中，急性肾损伤、凝血障碍、FFP 输注和输血与肝硬化密切相关，而 GI 出血、缺血性中风和颅内出血与肝硬化无关。30 天再入院 5028 例（9.18%），肝硬化组 167 例（18.5%），无肝硬化组 4861 例（9%）（P=0.01）。在多变量 Cox 回归中，CHA2DS2-Vasc 评分 6 分与 30 天再入院的相关性显著高于其他评分[风险比 2.24；95%置信区间（1.58-3.16）；P<0.001]。
肝硬化患者接受左心耳封堵术的 GI 出血和中风发生率相似，但 30 天再入院率较高。较高的 CHA2DS2-Vasc 评分更可能与 30 天再入院相关，因此有助于制定出院计划。LAAO 在肝硬化人群中的长期安全性和疗效仍需进一步证实。
