CHA₂DS₂-VASc Score as Predictor of New-Onset Atrial Fibrillation and Mortality in Critical COVID-19 Patients.

IF 3 3区医学 Q2 CRITICAL CARE MEDICINE Journal of Intensive Care Medicine Pub Date : 2024-08-07 DOI:10.1177/08850666241272068

Panagiotis S Ioannidis, Maria Sileli, Eleni Kerezidou, Myrto Kamaterou, Christina Iasonidou, Nikos Kapravelos

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Abstract

Background: Pre-existing and new-onset atrial fibrillation (NOAF) is a common arrhythmia in COVID-19 patients and is related to increased mortality. CHA₂DS₂-VASc score was initially developed to evaluate thromboembolic risk in patients with AF. Moreover, it predicted adverse outcomes in other clinical conditions, including SARS-CoV-2 infection. We aimed to evaluate the association of CHA₂DS₂-VASc with NOAF, ICU length of stay (LOS) and mortality in critically ill COVID-19 patients. We also examined the relationship of NOAF with mortality. We reviewed the literature to describe the link between cardiovascular risk factors and inflammatory response of severe COVID-19.

Methods and results: We retrospectively studied 163 COVID-19 patients admitted to a level 3 general ICU from March 2020 to April 2022. Patients were of advanced age (median 64 years, IQR 56.5-71) and the majority of them were male (67.5%). Regarding NOAF, we excluded 12 patients with AF history. In this group, CHA₂DS₂VASc score was significantly elevated (3 IQR (1-4) versus 1 IQR (1-2.75), p = 0.003). Specifically, three components of CHA₂DS₂VASc were notably increased: age (p < 0.001), arterial hypertension (p = 0.042) and stroke (p = 0.047). ICU mortality was raised in the NOAF group [75.8% versus 34.8%, p < 0.001 OR 5.87, 95% CI (2.43, 14.17)]. This was significant even after adjusting for ICU clinical scores (APACHE II and SOFA). About mortality in the entire sample, survivors were younger (p = 0.001). Non-survivors had greater APACHE II (p = 0.04) and SOFA (p = 0.033) scores. CHA₂DS₂VASc score was positively associated with mortality [p = 0.031, OR 1.28, 95% CI (1.03, 1.6)]. ICU length of stay was associated with mortality (p = 0.016) but not with CHA₂DS₂VASc score (p = 0.842).

Conclusions: NOAF and CHA₂DS₂VASc score were associated with higher mortality in COVID-19 ICU patients. CHA₂DS₂VASc score was also associated with NOAF but not with ICU LOS.

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CHA2DS2-VASc 评分作为 COVID-19 危重患者新发心房颤动和死亡率的预测指标

背景：原有和新发心房颤动（NOAF）是 COVID-19 患者常见的心律失常，与死亡率增加有关。CHA2DS2-VASc 评分最初是为了评估心房颤动患者的血栓栓塞风险而开发的。此外，它还能预测包括 SARS-CoV-2 感染在内的其他临床症状的不良后果。我们的目的是评估 CHA2DS2-VASc 与 COVID-19 重症患者的 NOAF、重症监护室住院时间（LOS）和死亡率之间的关系。我们还研究了 NOAF 与死亡率的关系。我们回顾了相关文献，以描述心血管风险因素与重症 COVID-19 炎症反应之间的联系：我们回顾性研究了 2020 年 3 月至 2022 年 4 月期间入住三级普通 ICU 的 163 名 COVID-19 患者。患者年龄偏大（中位数为 64 岁，IQR 为 56.5-71），男性占多数（67.5%）。关于无房颤，我们排除了 12 名有房颤病史的患者。这组患者的 CHA2DS2VASc 评分明显升高（3 IQR (1-4) 对 1 IQR (1-2.75)，P = 0.003）。具体而言，CHA2DS2VASc 的三个组成部分明显增加：年龄（p 2DS2VASc 评分与死亡率呈正相关[p = 0.031，OR 1.28，95% CI (1.03，1.6)]。ICU 住院时间与死亡率相关（p = 0.016），但与 CHA2DS2VASc 评分无关（p = 0.842）：结论：NOAF和CHA2DS2VASc评分与COVID-19 ICU患者死亡率升高有关。CHA2DS2VASc评分也与NOAF相关，但与ICU LOS无关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Intensive Care Medicine CRITICAL CARE MEDICINE-

CiteScore

7.60

自引率

3.20%

发文量

107

期刊介绍： Journal of Intensive Care Medicine (JIC) is a peer-reviewed bi-monthly journal offering medical and surgical clinicians in adult and pediatric intensive care state-of-the-art, broad-based analytic reviews and updates, original articles, reports of large clinical series, techniques and procedures, topic-specific electronic resources, book reviews, and editorials on all aspects of intensive/critical/coronary care.