脓毒症患者新发房颤的节律控制与心率控制药物比较：MIMIC-IV数据库分析

Comparison of rhythm and rate control medications for new-onset atrial fibrillation in septic patients: MIMIC-IV database analysis.

作者信息

Weng Cuilian, Lin Jian, Liu Qinghua, Zou Chang-Hong, Zheng Mingyu, Jiang Tingting, Jiang Linqian, Zhuang Xiao-Feng, Feng Hangwei

机构信息

Department of Intensive Care Unit, The Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fujian Provincial Hospital South Branch, No. 516, Jinrong South, Fuzhou, Fujian Province, China.

Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China.

出版信息

J Transl Med. 2025 May 7;23(1):512. doi: 10.1186/s12967-025-06380-y.

DOI:10.1186/s12967-025-06380-y

PMID:40336017

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12057229/

Abstract

BACKGROUND

The optimal management strategy for new-onset atrial fibrillation (NOAF) in patients with sepsis remains unclear. This study aimed to investigate and compare the associations of rhythm control medications versus rate control medications with mortality outcomes in septic patients with NOAF.

METHODS

This propensity score-matched cohort study utilized data from the Medical Information Mart in Intensive Care-IV database. Adult septic patients with NOAF were categorized into two groups based on initial medications (rhythm or rate control). The primary outcome was 28-day mortality, with secondary outcomes including intensive care unit(ICU),1-year mortality.

RESULTS

A total of 586 patients were included in the prematched cohort, with 277 patients remaining after propensity score matching. In the matched cohort, the primary outcome of 28-day mortality rate was 49.7% (85/171) in the rate control group and 46.2% (49/106) in the rhythm control group, with no significant difference between the groups (HR 0.97; 95% CI 0.68-1.37,P = 0.849). Secondary outcomes showed that rhythm control medications were not associated with increased ICU mortality (HR 1.03, 95% CI 0.60-1.78, P = 0.906) or 1-year mortality (HR 0.84, 95% CI 0.61-1.16, P = 0.299).However, the rhythm control group had higher successful cardioversion rates compared to the rate control group at 6 h (68.9% vs. 49.1%, P = 0.001), 12 h (71.1% vs. 52.4%, P = 0.002), and 24 h (72.7% vs. 53.2%, P = 0.002).

CONCLUSIONS

In septic patients with NOAF, rhythm control and rate control medications showed no difference in 28-day, ICU, or 1-year mortality.However, rhythm control may provide transient hemodynamic stabilization through rapid cardioversion, potentially beneficial during acute critical illness.

摘要

背景

脓毒症患者新发房颤（NOAF）的最佳管理策略仍不明确。本研究旨在调查和比较节律控制药物与心率控制药物对脓毒症合并NOAF患者死亡率的影响。

方法

本倾向评分匹配队列研究使用了重症监护-IV数据库中医疗信息集市的数据。成年脓毒症合并NOAF患者根据初始用药（节律或心率控制）分为两组。主要结局为28天死亡率，次要结局包括重症监护病房（ICU）、1年死亡率。

结果

预匹配队列共纳入586例患者，倾向评分匹配后剩余277例患者。在匹配队列中，心率控制组28天死亡率的主要结局为49.7%（85/171），节律控制组为46.2%（49/106），两组之间无显著差异（HR 0.97；95%CI 0.68-1.37，P = 0.849）。次要结局显示，节律控制药物与ICU死亡率增加（HR 1.03，95%CI 0.60-1.78，P = 0.906）或1年死亡率增加（HR 0.84，95%CI 0.61-1.16，P = 0.299）无关。然而，节律控制组在6小时（68.9%对49.1%，P = 0.001）、12小时（71.1%对52.4%，P = 0.002）和24小时（72.7%对53.2%，P = 0.002）时的成功复律率高于心率控制组。