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. 2021 Aug;9(15):1239.
doi: 10.21037/atm-21-3111.

Atrial fibrillation increases inpatient and 4-year all-cause mortality in critically ill patients with liver cirrhosis

Yanting Luo  1 , Bingyuan Wu  1 , Yuankai Wu  2 , Long Peng  1 , Zexiong Li  1 , Jieming Zhu  1 , Zhongzhen Su  3 , Jinlai Liu  1 , Suhua Li  1 , Yutian Chong  2
Affiliations

Atrial fibrillation increases inpatient and 4-year all-cause mortality in critically ill patients with liver cirrhosis

Yanting Luo et al. Ann Transl Med. 2021 Aug.

Abstract

Background: The association between atrial fibrillation (AF) and cirrhosis is unclear. Therefore, the aim of the present study was to determine the association between AF and short-term and 4-year mortality in critically ill patients with cirrhosis using a large database.

Methods: The Medical Information Mart for Intensive Care III (MIMIC III) database was used to identify patients with cirrhosis hospitalized in an intensive care unit from 2001 to 2012. Demographic and clinical data were extracted from the database. Clinical data and demographic information were collected for each patient in our study. Kaplan-Meier analysis and multivariate Cox regression models were performed to examine the relation between atrial fibrillation and in-hospital and 4-year all-cause mortality.

Results: A total of 1,481 patients (mean age: 58 years, 68% male) with liver cirrhosis were included in the analysis, and the prevalence of AF was 14.18%. The inpatient all-cause mortality rate was 26.6%, and patients who died in hospital had a significantly higher rate of AF (21.57% vs. 11.50%, P<0.001). Multivariate Cox regression analysis indicated that AF was significantly associated with inpatient all-cause mortality [hazard ratio (HR): 1.52, 95% confidence interval (CI): 1.19-1.95, P<0.001], and 4-year all-cause mortality (HR: 1.55, 95% CI: 1.12-2.13, P=0.008). Kaplan-Meier survival analysis showed that patients with AF had a significantly higher inpatient and 4-year all-cause mortality.

Conclusions: Critically ill patients with liver cirrhosis have a high rate of AF, and the presence of AF is an independent risk factor for inpatient and 4-year all-cause mortality.

Keywords: Atrial fibrillation (AF); anticoagulation; critically ill patients; liver cirrhosis; mortality.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/atm-21-3111). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow diagram of patient inclusion. ICU, intensive care unit.
Figure 2
Figure 2
Survival curve analysis of AF in liver cirrhosis patient. Kaplan-Meier plots of inpatient Cumulative survival (A). Cox regression plots of inpatient Cumulative survival (B). Kaplan-Meier plots of 4-year Cumulative survival (C). Cox regression plots of 4-year Cumulative survival (D).
Figure 3
Figure 3
Kaplan-Meier survival curve analysis of AC in liver cirrhosis patients with AF. Kaplan-Meier plots of inpatient cumulative survival (A). Kaplan-Meier plots of 4-year cumulative survival (B). Kaplan-Meier plots of Landmark analysis before 2.5 years cumulative survival (C). Kaplan-Meier plots of Landmark analysis after 2.5 years cumulative survival (D).
See this image and copyright information in PMC

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