Takuo Yoshida, Shigehiko Uchino, Yusuke Sasabuchi, Yasuhiro Hagiwara, Tomonao Yoshida, Hiroshi Nashiki, Hajime Suzuki, Hiroshi Takahashi, Yuki Kishihara, Shinya Nagasaki, Tomoya Okazaki, Shinshu Katayama, Masaaki Sakuraya, Takayuki Ogura, Satoki Inoue, Masatoshi Uchida, Yuka Osaki, Akira Kuriyama, Hiromasa Irie, Michihito Kyo, Nozomu Shima, Junichi Saito, Izumi Nakayama, Naruhiro Jingushi, Kei Nishiyama, Takahiro Masuda, Yasuyuki Tsujita, Masatoshi Okumura, Haruka Inoue, Yoshitaka Aoki, Takashiro Kondo, Isao Nagata, Takashi Igarashi, Nobuyuki Saito, Masato Nakasone
INTENSIVE CARE MEDICINE 46 1 27 - 35 2020年01月
Purpose The development of new-onset atrial fibrillation (AF) in critically ill patients may be associated with poor outcomes. However, it is unknown whether sustained new-onset AF contributes to worse outcome. The aim of this study was to assess whether sustained new-onset AF is associated with stroke and death and to look for a possible dose-response relationship between AF duration and death. Methods In a prospective cohort study conducted in 32 intensive care units in Japan from 2017 to 2018, we enrolled adult patients with new-onset AF. We compared patients with AF duration longer than 48 h with those with AF duration shorter than 48 h. To assess a dose-response relationship between AF duration and hospital mortality, we conducted landmark analysis and time-dependent Cox regression analysis. Results Among a total of 423 new-onset AF patients, hospital mortality was 25%, and the incidence of in-hospital stroke was 4.6%. AF duration longer than 48 h was not independently associated with hospital mortality (adjusted odds ratio: 1.52; 95% Confidence Interval: 0.87-2.64). The incidence of in-hospital stroke was 7.6% in patients with AF duration longer than 48 h and 3.8% in those with AF duration shorter than 48 h (p = 0.154). When analyzing time more continuously, we observed a time-dependent association between AF duration and hospital mortality (p = 0.005 by landmark analysis and p = 0.019 by Cox analysis). Conclusions Sustained new-onset AF was time-dependently associated with hospital mortality in ICU patients, albeit with some uncertainty since AF duration longer than 48 h was not independently associated with in-hospital death or stroke.