Gacouin Arnaud, Guillot Pauline, Delamaire Flora, Le Corre Alexia, Quelven Quentin, Terzi Nicolas, Tadié Jean Marc, Maamar Adel
CHU Rennes, Maladies Infectieuses et Réanimation Médicale, F-35033 Rennes, France.
Université Rennes 1, Faculté de Médecine, Biosit, F-35043 Rennes, France.
Int J Cardiol Cardiovasc Risk Prev. 2024 Aug 10;22:200318. doi: 10.1016/j.ijcrp.2024.200318. eCollection 2024 Sep.
Histor of coronary artery disease (CAD) and/or atrial fibrillation (AF) and/or valvular replacement (VR) are prevalent among patients admitted to intensive care units (ICUs). The impact of these conditions on outcomes in patients with acute respiratory distress syndrome (ARDS) remains insufficiently explored.
We performed a retrospective study on prospectively collected data from patients with ARDS and a PaO/FiO ratio ≤150 mmHg. Patients were admitted between January 2006 and March 2022. We used multivariable logistic regression analysis. The primary outcome was 1-year mortality from admission to the ICU; secondary outcomes included mortality at 28 days and 90 days.
Among 1.033 patients, 181 (17.5 %) had a history of CAD and/or AF and/or VR. History of CAD and/or AF and/or VR was independently associated with 1-year mortality (Odds-Ratio (OR) = 2.59, 95 % confidence interval (CI) 1.76-3.82, p < 0.001), with mortality at 90 days (OR = 1.87, 95 % CI 1.27-2.76, p = 0.001), but not with mortality at 28 days (OR = 1.40, 95 % CI 0.93-2.11, p = 0.10). In sensitivity analyses, history of CAD and/or AF and/or VR remained independently associated with 1-year mortality in ICU survivors (OR = 3.58, 95 % CI = 2.41-7.82, p < 0.001).
History of CAD and/or AF and/or VR was associated with mortality in ARDS. Prompt referral to cardiologists for comprehensive management post-ICU discharge may be warranted to optimize outcomes in this vulnerable population.
冠心病（CAD）和/或心房颤动（AF）和/或瓣膜置换（VR）病史在入住重症监护病房（ICU）的患者中很常见。这些情况对急性呼吸窘迫综合征（ARDS）患者预后的影响仍未得到充分研究。
我们对前瞻性收集的ARDS且动脉血氧分压/吸入氧分数值（PaO₂/FiO₂）≤150 mmHg患者的数据进行了回顾性研究。患者于2006年1月至2022年3月入院。我们使用多变量逻辑回归分析。主要结局是从入住ICU起1年的死亡率；次要结局包括28天和90天的死亡率。
在1033例患者中，181例（17.5%）有CAD和/或AF和/或VR病史。CAD和/或AF和/或VR病史与1年死亡率独立相关（比值比（OR）=2.59，95%置信区间（CI）1.76 - 3.82，p<0.001），与90天死亡率相关（OR = 1.87，95%CI 1.27 - 2.76，p = 0.001），但与28天死亡率无关（OR = 1.40，95%CI 0.93 - 2.11，p = 0.10）。在敏感性分析中，CAD和/或AF和/或VR病史在ICU幸存者中仍与1年死亡率独立相关（OR = 3.58，95%CI = 2.41 - 7.82，p<0.001）。
CAD和/或AF和/或VR病史与ARDS患者的死亡率相关。ICU出院后及时转诊至心脏病专家进行综合管理，可能有助于优化这一脆弱人群的预后。
