新发房颤对重症患者死亡率及住院时间影响的Meta分析-现代医学

新发房颤对重症患者死亡率及住院时间影响的Meta分析

单位：南京中医药大学附属医院重症医学科, 江苏南京 210029

分类号：R541.7

出版年·卷·期（页码）：2022·50·第十一期（1387-1396）

摘要：

目的：比较新发房颤与未发房颤的重症患者死亡率及住院时间的差异，评价新发房颤对重症患者预后的影响。方法：检索MEDLINE、Embase、ScienceDirect、Highwire、Cochrane图书馆临床随机对照试验资料库、万方数据库及中国知网全文期刊数据库2000年1月至2020年12月发表的评价新发房颤对重症患者死亡率及住院时间影响的临床研究。由2名评价者分别进行文献筛选并对纳入研究的文献进行数据提取。采用RevMan 5.3软件对数据资料进行分析，采用漏斗图分析入选文献是否存在发表偏倚。结果：本研究共纳入22项研究，均为英文文献。研究共纳入89 930例患者，其中新发房颤8 004例，未发生房颤81 926例。Meta分析显示，新发房颤可增加重症患者住院死亡风险(OR=2.68，95%CI 2.19～3.27，P＜0.000 01)及ICU死亡风险(OR=2.41，95%CI 2.08～2.79，P＜0.000 01)；新发房颤可延长重症患者总住院时间(SMD=1.30，95%CI 0.45～2.16，P=0.003)及ICU住院时间(SMD=1.32，95%CI 1.06～1.59，P＜0.000 01)。结论：新发房颤将延长重症患者住院时间并增加死亡风险，需更多研究以评价相关危险因素并采取预防措施。

Objective: To systematically evaluate the effect of new-onset atrial fibrillation on mortality and length of hospital stay in critically ill patients. Methods: The databases of Medline, Embase, ScienceDirect, Highwire, Cochrane Library database, Wanfang database and China National Knowledge Infrastructure(CNKI) were retrieved for collecting the clinical studies comparing the mortality and length of stay in critically ill patients with or without new-onset atrial fibrillation from January 2000 to December 2020. The literatures were screened according to the standard, and the data was extracted by 2 researchers independently and the quality was evaluated. Meta-analysis was performed using RevMan 5.3 software. Sensitivity analysis was used to evaluate the stability of the results. Funnel plots were used to evaluate publication bias. Results: A total of 22 studies and 89 930 patients were enrolled, including 8 004 patients with new-onset atrial fibrillation and 81 926 patients without atrial fibrillation. The results of meta-analysis showed that new-onset atrial fibrillation was correlated to the increased risk of hospital death[odds ratio(OR) =2.68, 95% confidence interval(CI) 2.19～3.27, P＜0.000 01]and ICU death(OR = 2.41, 95% CI 2.08～2.79，P＜0.000 01). New-onset atrial fibrillation could also prolong the length of hospital stay[standardized mean difference(SMD) =1.30, 95%CI 0.45～2.16,P=0.003) and the length of ICU stay(SMD =1.32, 95%CI 1.06～1.59,P＜0.000 01). Sensitivity analysis showed that there was no significant change in the overall results. Funnel plots showed that there was no significant publication bias in the included studies. Conclusion: New-onset atrial fibrillation can prolong the length of hospital/ICU stay and increase the risk of hospital/ICU death of critically ill patients, and further studies should be done to evaluate the risk factors and efficacy of preventions.

参考文献：

[1] OMAE T,INADA E.New-onset atrial fibrillation:an update[J].J Anesth,2018,32(3):414-424.
[2] HOBBS F R,TAYLOR C J,JAN GEERSING G,et al.European Primary Care Cardiovascular Society(EPCCS) consensus guidance on stroke prevention in atrial fibrillation(SPAF) in primary care[J].Eur J Prev Cardiol,2016,23(5):460-473.
[3] BOSCH N A,CIMINI J,WALKEY A J.Atrial fibrillation in the ICU[J].Chest,2018,154(6):1424-1434.
[4] YOSHIDA T,FUJII T,UCHINO S,et al.Epidemiology,prevention,and treatment of new-onset atrial fibrillation in critically ill:a systematic review[J].J Intensive Care,2015,3(1):19.
[5] LI Y,PASTORI D,GUO Y,et al.Risk factors for new-onset atrial fibrillation:a focus on Asian populations[J].Int J Cardiol,2018,261:92-98.
[6] KLEINKLOUWENBERG P M,FRENCKEN J F,KUIPERS S,et al.MARS Consortium:Incidence,predictors,and outcomes of new-onset atrial fibrillation in critically ill patients with sepsis.A cohort study[J].Am J Respir Crit Care Med,2017,195(2):205-211.
[7] GANDHI S,LITT D,NARULA N.New-onset atrial fibrillation in sepsis is associated with increased morbidity and mortality[J].Neth Heart J,2015,23(2):82-88.
[8] KANJANAHATTAKIJ N,RATTANAWONG P,KRISHNAMOORTHY P,et al.New-onset atrial fibrillation is associated with increased mortality in critically ill patients:a systematic review and meta-analysis[J].Acta Cardiol,2019,74(2):162-169.
[9] FERNANDO S M,MATHEW R,HIBBERT B,et al.New-onset atrial fibrillation and associated outcomes and resource use among critically ill adults-a multicenter retrospective cohort study[J].Crit Care,2020,24(1):15.
[10] JACOBS M S,LOEF B,REIDINGA A C,et al.Incidence,treatment and mortality of new-onset atrial fibrillation patients at the intensive care unit[J].Open Heart,2020,7(1):e001226.
[11] BEDFORD J P,GERRY S,HATCH R A,et al.Hospital outcomes associated with new-onset atrial fibrillation during ICU admission:a multicentre competing risks analysis[J].J Crit Care,2020,60:72-78.
[12] SEGUIN P,SIGNOURET T,LAVIOLLE B,et al.Incidence and risk factors of atrial fibrillation in a surgical intensive care unit[J].Crit Care Med,2004,32(3):722-726.
[13] SEGUIN P,LAVIOLLE B,MAURICE A,et al.Atrial fibrillation in trauma patients requiring intensive care[J].Intensive Care Med,2006,32(3):398-404.
[14] ARORA S,LANG I,NAYYAR V,et al.Atrial fibrillation in a tertiary care multidisciplinary intensive care unit--incidence and risk factors[J].Anaesth Intensive Care,2007,35(5):707-713.
[15] SALMAN S,BAJWA A,GAJIC O,et al.Paroxysmal atrial fibrillation in critically ill patients with sepsis[J].J Intensive Care Med,2008,23(3):178-183.
[16] CHRISTIAN S A,SCHORR C,FERCHAU L,et al.Clinical characteristics and outcomes of septic patients with new-onset atrial fibrillation[J].J Crit Care,2008,23(4):532-536.
[17] MEIERHENRICH R,STEINHILBER E,EGGERMANN C,et al.Incidence and prognostic impact of new-onset atrial fibrillation in patients with septic shock:a prospective observational study[J].Crit Care,2010,14(3):R108.
[18] WELLS G L,MORRIS P E.Incidence and prognosis of atrial fibrillation in patients with sepsis[J].Cardiol Res,2011,2(6):293-297.
[19] WALKEY A J,WIENER R S,GHOBRIAL J M,et al.Incident stroke and mortality associated with new-onset atrial fibrillation in patients hospitalized with severe sepsis[J].JAMA,2011,306(20):2248-2254.
[20] GUENANCIA C,BINQUET C,LAURENT G,et al.Incidence and predictors of new-onset atrial fibrillation in septic shock patients in a medical ICU:data from 7-day holter ECG monitoring[J].PLoS One,2015,10(5):e0127168.
[21] GUPTA S,TIRUVOIPATI R,GREEN C.Atrial Fibrillation and mortality in critically ill patients:a Retrospective study[J].Am J Crit Care,2015,24(4):336-341.
[22] CHEN A Y,SOKOL S S,KRESS J P,et al.New-onset atrial fibrillation is an independent predictor of mortality in medical intensive care unit patients[J].Ann Pharmacother,2015,49(5):523-527.
[23] SHAVER C M,CHEN W,JANZ D R,et al.Atrial fibrillation is an independent predictor of mortality in critically ill patients[J].Crit Care Med,2015,43(10):2104-2111.
[24] CARRERA P,THONGPRAYOON C,CHEUNGPASITPORN W,et al.Epidemiology and outcome of new-onset atrial fibrillation in the medical intensive care unit[J].J Crit Care,2016,36:102-106.
[25] LIU W C,LIN W Y,LIN C S,et al.Prognostic impact of restored sinus rhythm in patients with sepsis and new-onset atrial fibrillation[J].Crit Care,2016,20(1):373.
[26] MOSS T J,CALLAND J F,ENFIELD K B,et al.New-onset atrial fibrillation in the critically ill[J].Crit Care Med,2017,45(5):790-797.
[27] DUARTE P A,LEICHTWEIS G E,ANDRIOLO L,et al.Factors associated with the incidence and severity of new-onset atrial fibrillation in adult critically ill patients[J].Crit Care Res Pract,2017,2017:8046240.
[28] ARRIGO M,ISHIHARA S,FELIOT E,et al.New-onset atrial fibrillation in critically ill patients and its association with mortality:a report from the FROG-ICU study[J].Int J Cardiol,2018,266:95-99.
[29] MAKRYGIANNIS S S,RIZIKOU D,PATSOURAKOS N G,et al.New-onset atrial fibrillation and clinical outcome in non-cardiac intensive care unit patients[J].Aust Crit Care,2018,31(5):274-277.
[30] STANG A.Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses[J].Eur J Epidemiol,2010,25(9):603-605.
[31] KERWIN M,SAADO J,PAN J,et al.New-onset atrial fibrillation and outcomes following isolated coronary artery bypass surgery:a systematic review and meta-analysis[J].Clin Cardiol,2020,43(9):928-934.
[32] FILARDO G,AILAWADI G,POLLOCK B D,et al.Postoperative atrial fibrillation:sex-specific characteristics and effect on survival[J].J Thorac Cardiovasc Surg,2020,159(4):1419-1425.e1.
[33] KELLER M,MEIERHENRICH R.New onset atrial fibrillation in patients with sepsis[J].Anaesthesist,2017,66(10):786-794.
[34] WETTERSLEV M,HAASE N,HASSAGER C,et al.New-onset atrial fibrillation in adult critically ill patients:a scoping review[J].Intensive Care Med,2019,45(7):928-938.
[35] BOSCH N A,COHEN D M,WALKEY A J.Risk factors for new-onset atrial fibrillation in patients with sepsis:a systematic review and meta-analysis[J].Crit Care Med,2019,47(2):280-287.
[36] LUO D,WAN X,LIU J,et al.Optimally estimating the sample mean from the sample size,median,mid-range,and/or mid-quartile range[J].Stat Methods Med Res,2018,27(6):1785-1805.

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