CHADS-VASc 评分预测危重症 COVID-19 患者新发心房颤动和死亡风险。

CHADS-VASc Score as Predictor of New-Onset Atrial Fibrillation and Mortality in Critical COVID-19 Patients.

机构信息

Second Intensive Care Unit, "George Papanikolaou" General Hospital, Thessaloniki, Greece.

出版信息

J Intensive Care Med. 2024 Nov;39(11):1155-1163. doi: 10.1177/08850666241272068. Epub 2024 Aug 7.

DOI:10.1177/08850666241272068

PMID:39109625

Abstract

BACKGROUND

Pre-existing and new-onset atrial fibrillation (NOAF) is a common arrhythmia in COVID-19 patients and is related to increased mortality. CHADS-VASc score was initially developed to evaluate thromboembolic risk in patients with AF. Moreover, it predicted adverse outcomes in other clinical conditions, including SARS-CoV-2 infection. We aimed to evaluate the association of CHADS-VASc with NOAF, ICU length of stay (LOS) and mortality in critically ill COVID-19 patients. We also examined the relationship of NOAF with mortality. We reviewed the literature to describe the link between cardiovascular risk factors and inflammatory response of severe COVID-19.

METHODS AND RESULTS

We retrospectively studied 163 COVID-19 patients admitted to a level 3 general ICU from March 2020 to April 2022. Patients were of advanced age (median 64 years, IQR 56.5-71) and the majority of them were male (67.5%). Regarding NOAF, we excluded 12 patients with AF history. In this group, CHADSVASc score was significantly elevated (3 IQR (1-4) versus 1 IQR (1-2.75), p = 0.003). Specifically, three components of CHADSVASc were notably increased: age (p < 0.001), arterial hypertension (p = 0.042) and stroke (p = 0.047). ICU mortality was raised in the NOAF group [75.8% versus 34.8%, p < 0.001 OR 5.87, 95% CI (2.43, 14.17)]. This was significant even after adjusting for ICU clinical scores (APACHE II and SOFA). About mortality in the entire sample, survivors were younger (p = 0.001). Non-survivors had greater APACHE II (p = 0.04) and SOFA (p = 0.033) scores. CHADSVASc score was positively associated with mortality [p = 0.031, OR 1.28, 95% CI (1.03, 1.6)]. ICU length of stay was associated with mortality (p = 0.016) but not with CHADSVASc score (p = 0.842).

CONCLUSIONS

NOAF and CHADSVASc score were associated with higher mortality in COVID-19 ICU patients. CHADSVASc score was also associated with NOAF but not with ICU LOS.

摘要

背景

新冠肺炎患者中常出现房性心动过速（房颤），包括新发和原有房颤，且与死亡率增加相关。CHA2DS2-VASc 评分最初用于评估房颤患者的血栓栓塞风险。此外，该评分还可预测包括 SARS-CoV-2 感染在内的其他临床情况的不良结局。我们旨在评估 CHA2DS2-VASc 评分与新冠肺炎危重症患者新发房颤、重症监护病房（ICU）住院时间（LOS）和死亡率的相关性。我们还检查了新发房颤与死亡率的关系。我们查阅文献，描述了心血管危险因素与严重新冠肺炎的炎症反应之间的联系。

方法和结果

我们回顾性研究了 2020 年 3 月至 2022 年 4 月期间入住三级普通 ICU 的 163 名新冠肺炎患者。患者年龄较大（中位数 64 岁，IQR 56.5-71），大多数为男性（67.5%）。对于新发房颤，我们排除了 12 名有房颤病史的患者。在这组患者中，CHA2DS2-VASc 评分明显升高（3 IQR（1-4）比 1 IQR（1-2.75），p=0.003）。具体而言，CHA2DS2-VASc 的三个组成部分明显增加：年龄（p<0.001）、高血压（p=0.042）和中风（p=0.047）。新发房颤组 ICU 死亡率较高[75.8%比 34.8%，p<0.001，比值比（OR）5.87，95%置信区间（CI）（2.43，14.17）]。即使在调整了 ICU 临床评分（APACHE II 和 SOFA）后，这仍然具有统计学意义。关于整个样本的死亡率，幸存者年龄较小（p=0.001）。非幸存者的 APACHE II 评分（p=0.04）和 SOFA 评分（p=0.033）更高。CHA2DS2-VASc 评分与死亡率呈正相关（p=0.031，OR 1.28，95%CI（1.03，1.6））。ICU 住院时间与死亡率相关（p=0.016），但与 CHA2DS2-VASc 评分无关（p=0.842）。