Arrhythmias in Critically Ill Surgical and Non-surgical Patients: A National Propensity-Matched Study.
Journal
World journal of surgery
ISSN: 1432-2323
Titre abrégé: World J Surg
Pays: United States
ID NLM: 7704052
Informations de publication
Date de publication:
Nov 2023
Nov 2023
Historique:
accepted:
17
07
2023
medline:
23
10
2023
pubmed:
1
8
2023
entrez:
31
7
2023
Statut:
ppublish
Résumé
Arrhythmias are common in critically ill patients, though the impact of arrhythmias on surgical patients is not well delineated. We aimed to characterize mortality following arrhythmias in critically ill patients. We performed a propensity-matched retrospective analysis of intensive care unit (ICU) patients from 2007 to 2017 in the Cerner Acute Physiology and Chronic Health Evaluation database. We compared outcomes between patients with and without arrhythmias and those with and without surgical indications for ICU admission. We also modeled predictors of arrhythmias in surgical patients. 467,951 patients were included; 97,958 (20.9%) were surgical patients. Arrhythmias occurred in 1.4% of the study cohorts. Predictors of arrhythmias in surgical patients included a history of cardiovascular disease (odds ratio [OR] 1.35, 95% confidence interval [CI95] 1.11-1.63), respiratory failure (OR 1.48, CI95 1.12-1.96), pneumonia (OR 3.17, CI95 1.98-5.10), higher bicarbonate level (OR 1.03, CI95 1.01-1.05), lower albumin level (OR 0.79, CI95 0.68-0.91), and vasopressor requirement (OR 27.2, CI95 22.0-33.7). After propensity matching, surgical patients with arrhythmias had a 42% mortality risk reduction compared to non-surgical patients (risk ratio [RR] 0.58, CI 95 0.43-0.79). Predicted probabilities of mortality for surgical patients were lower at all ages. Surgical patients with arrhythmias are at lower risk of mortality than non-surgical patients. In this propensity-matched analysis, predictors of arrhythmias in critically ill surgical patients included a history of cardiovascular disease, respiratory complications, increased bicarbonate levels, decreased albumin levels, and vasopressor requirement. These findings highlight the differential effect of arrhythmias on different cohorts of critically ill populations.
Sections du résumé
BACKGROUND
BACKGROUND
Arrhythmias are common in critically ill patients, though the impact of arrhythmias on surgical patients is not well delineated. We aimed to characterize mortality following arrhythmias in critically ill patients.
METHODS
METHODS
We performed a propensity-matched retrospective analysis of intensive care unit (ICU) patients from 2007 to 2017 in the Cerner Acute Physiology and Chronic Health Evaluation database. We compared outcomes between patients with and without arrhythmias and those with and without surgical indications for ICU admission. We also modeled predictors of arrhythmias in surgical patients.
RESULTS
RESULTS
467,951 patients were included; 97,958 (20.9%) were surgical patients. Arrhythmias occurred in 1.4% of the study cohorts. Predictors of arrhythmias in surgical patients included a history of cardiovascular disease (odds ratio [OR] 1.35, 95% confidence interval [CI95] 1.11-1.63), respiratory failure (OR 1.48, CI95 1.12-1.96), pneumonia (OR 3.17, CI95 1.98-5.10), higher bicarbonate level (OR 1.03, CI95 1.01-1.05), lower albumin level (OR 0.79, CI95 0.68-0.91), and vasopressor requirement (OR 27.2, CI95 22.0-33.7). After propensity matching, surgical patients with arrhythmias had a 42% mortality risk reduction compared to non-surgical patients (risk ratio [RR] 0.58, CI 95 0.43-0.79). Predicted probabilities of mortality for surgical patients were lower at all ages.
CONCLUSIONS
CONCLUSIONS
Surgical patients with arrhythmias are at lower risk of mortality than non-surgical patients. In this propensity-matched analysis, predictors of arrhythmias in critically ill surgical patients included a history of cardiovascular disease, respiratory complications, increased bicarbonate levels, decreased albumin levels, and vasopressor requirement. These findings highlight the differential effect of arrhythmias on different cohorts of critically ill populations.
Identifiants
pubmed: 37524957
doi: 10.1007/s00268-023-07129-8
pii: 10.1007/s00268-023-07129-8
doi:
Substances chimiques
Bicarbonates
0
Vasoconstrictor Agents
0
Albumins
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2668-2675Informations de copyright
© 2023. The Author(s) under exclusive licence to Société Internationale de Chirurgie.
Références
Reinelt P, Karth GD, Geppert A et al (2001) Incidence and type of cardiac arrhythmias in critically ill patients: a single center experience in a medical-cardiological ICU. Intensive Care Med 27(9):1466–1473
doi: 10.1007/s001340101043
pubmed: 11685339
Annane D, Sebille V, Duboc D et al (2008) Incidence and prognosis of sustained arrhythmias in critically ill patients. Am J Respir Crit Care Med 178(1):20–25
doi: 10.1164/rccm.200701-031OC
pubmed: 18388358
Wong DT, Cheng D, Kustra R et al (1999) Risk factors of delayed extubation, prolonged length of stay in the intensive care unit, and mortality in patients undergoing coronary artery bypass graft with fast-track cardiac anesthesia. Anesthesiology 91:936–944
doi: 10.1097/00000542-199910000-00012
pubmed: 10519495
Tse G (2016) Mechanisms of cardiac arrhythmias. J Arrhythm 32(2):75–81
doi: 10.1016/j.joa.2015.11.003
pubmed: 27092186
Antzelevitch C, Burashnikov A (2011) Overview of basic mechanisms of cardiac arrhythmia. Card Electrophysiol Clin 3(1):23–45
doi: 10.1016/j.ccep.2010.10.012
pubmed: 21892379
pmcid: 3164530
Coumel P (1989) Classification of human arrhythmias. In: Vaughan Williams EM (ed) Antiarrhythmic drugs. Handbook of experimental pharmacology, vol 89. Springer, Berlin Heidelberg
Chung MK, Martin DO, Sprecher D et al (2001) C-reactive protein elevation in patients with atrial arrhythmias: inflammatory mechanisms and persistence of atrial fibrillation. Circulation 104:2886–3289
doi: 10.1161/hc4901.101760
pubmed: 11739301
Kanji S, Williamson DR, Yaghchi BM, et al. Canadian Critical Care Trials Group (2012) Epidemiology and management of atrial fibrillation in medical and noncardiac surgical adult intensive care unit patients. J Crit Care, 27(3):326.e1–326.e3268
Echahidi N, Pibarot P, O’Hara G et al (2008) Mechanisms, prevention, and treatment of atrial fibrillation after cardiac surgery. J Am Coll Cardiol 51(8):793–801
doi: 10.1016/j.jacc.2007.10.043
pubmed: 18294562
Gillinov AM, Bagiella E, Moskowitz AJ et al (2016) Rate control versus rhythm control for atrial fibrillation after cardiac surgery. N Engl J Med 374(20):1911–1921
doi: 10.1056/NEJMoa1602002
pubmed: 27043047
pmcid: 4908812
Ganguly S, Brown T, Pritchett C et al (2015) Atrial fibrillation in intensive care. Intensive Care Med Exp 3(Suppl 1):A209
doi: 10.1186/2197-425X-3-S1-A209
pmcid: 4797069
Guenancia C, Binquet C, Laurent G et al (2015) Incidence and predictors of new-onset atrial fibrillation in septic shock patients in a medical ICU: data from 7-day holter ECG monitoring. PLoS ONE 10(5):e0127168
doi: 10.1371/journal.pone.0127168
pubmed: 25965915
pmcid: 4428753
Zimmerman JE, Kramer AA, McNair DS et al (2006) Acute physiology and chronic health evaluation (APACHE) IV: hospital mortality assessment for today’s critically ill patients. Crit Care Med 34(5):1297–1310
doi: 10.1097/01.CCM.0000215112.84523.F0
pubmed: 16540951
Knaus WA, Wagner DP, Draper EA et al (1991) The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 100(6):1619–1636
doi: 10.1378/chest.100.6.1619
pubmed: 1959406
Dobrev D, Aguilar M, Heijman J et al (2019) Postoperative atrial fibrillation: mechanisms, manifestations and management. Nat Rev Cardiol 16(7):417–436
doi: 10.1038/s41569-019-0166-5
pubmed: 30792496
Wetterslev M, Hylander Møller M, Granholm A et al (2023) Atrial fibrillation (AFIB) in the ICU: incidence, risk factors, and outcomes: the international AFIB-ICU cohort study. Crit Care Med. https://doi.org/10.1097/CCM.0000000000005883
doi: 10.1097/CCM.0000000000005883
pubmed: 37078722
Arrigo M, Ishihara S, Feliot E et al (2018) New-onset atrial fibrillation in critically ill patients and its association with mortality: a report from the FROG-ICU study. Int J Cardiol 266:95–99
doi: 10.1016/j.ijcard.2018.03.051
pubmed: 29887481
Meierhenrich R, Steinhilber E, Eggermann C et al (2010) Incidence and prognostic impact of new-onset atrial fibrillation in patients with septic shock: a prospective observational study. Crit Care 14(3):R108
doi: 10.1186/cc9057
pubmed: 20537138
pmcid: 2911754
Healey JS, Connolly SJ, Gold MR, et al. (2012) Subclinical atrial fibrillation and the risk of stroke [published correction appears in N Engl J Med. 2016 Mar 10;374(10):998]. N Engl J Med, 366(2):120–129.
Valderrábano RJ, Blanco A, Santiago-Rodriguez EJ et al (2016) Risk factors and clinical outcomes of arrhythmias in the medical intensive care unit. J Intensive Care 4:9
doi: 10.1186/s40560-016-0131-x
pubmed: 26807261
pmcid: 4724077
Bosch NA, Cimini J, Walkey AJ (2018) Atrial fibrillation in the ICU. Chest 154(6):1424–1434
doi: 10.1016/j.chest.2018.03.040
pubmed: 29627355
pmcid: 6335260
Christian SA, Schorr C, Ferchau L et al (2008) Clinical characteristics and outcomes of septic patients with new-onset atrial fibrillation. J Crit Care 23(4):532–536
doi: 10.1016/j.jcrc.2007.09.005
pubmed: 19056018
Walkey AJ, Wiener RS, Ghobrial JM et al (2011) Incident stroke and mortality associated with new-onset atrial fibrillation in patients hospitalized with severe sepsis. JAMA 306(20):2248–2254
doi: 10.1001/jama.2011.1615
pubmed: 22081378
pmcid: 3408087
Bruins P, te Velthuis H, Yazdanbakhsh AP et al (1997) Activation of the complement system during and after cardiopulmonary bypass surgery: postsurgery activation involves C-reactive protein and is associated with postoperative arrhythmia. Circulation 96(10):3542–3548
doi: 10.1161/01.CIR.96.10.3542
pubmed: 9396453
van Beek DEC, Kuijpers YAM, Königs MHH et al (2020) Low serum albumin levels and new-onset atrial fibrillation in the ICU: a prospective cohort study. J Crit Care 56:26–30
doi: 10.1016/j.jcrc.2019.11.011
pubmed: 31805465
Saliba W, Wazni OM (2011) Sinus rhythm restoration and treatment success: insight from recent clinical trials. Clin Cardiol 34(1):12–22
doi: 10.1002/clc.20826
pubmed: 21259273
pmcid: 6652478
Shahreyar M, Fahhoum R, Akinseye O et al (2018) Severe sepsis and cardiac arrhythmias. Ann Transl Med 6(1):6
doi: 10.21037/atm.2017.12.26
pubmed: 29404352
pmcid: 5787725
POISE Study Group, Devereaux PJ, Yang H et al (2008) Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet 371(9627):1839–1847
doi: 10.1016/S0140-6736(08)60601-7
Bangalore S, Wetterslev J, Pranesh S et al (2008) Perioperative beta blockers in patients having non-cardiac surgery: a meta-analysis. Lancet 372(9654):1962–1976
doi: 10.1016/S0140-6736(08)61560-3
pubmed: 19012955
Walkey AJ, Myers LC, Thai KK et al (2023) Practice patterns and outcomes associated with anticoagulation use following sepsis hospitalizations with new-onset atrial fibrillation. Circ Cardiovasc Qual Outcomes 16(3):e009494
doi: 10.1161/CIRCOUTCOMES.122.009494
pubmed: 36852680
Rahman F, Wang N, Yin X et al (2016) Atrial flutter: clinical risk factors and adverse outcomes in the Framingham Heart Study. Heart Rhythm 13(1):233–240
doi: 10.1016/j.hrthm.2015.07.031
pubmed: 26226213