Fatemeh Sadat Rahimi1, Siamak Afaghi2, Farzad Esmaeili Tarki2, Hossein Salehi Omran2, Mohammad Hossein Nasirpour3. 1. Department of Surgery, Clinical Research and Development Center, Shahid Modarres Hospital Shahid Beheshti University of Medical Sciences Tehran Iran. 2. Research Institute of Internal Medicine, Shahid Modarres Hospital Shahid Beheshti University of Medical Sciences Tehran Iran. 3. Department of Biomedical Sciences, College of Medicine Florida State University Tallahassee Florida USA.
Abstract
Background and Aims: We focused on determining the risk factors, thromboembolic events, and clinical course of New-Onset Atrial Fibrillation (NOAF) among hospitalized coronavirus disease (COVID-19) patients. Methods: This retrospective study was conducted in the major referral centers in Tehran, Iran. Of 1764 patients enrolled in the study from January 2020 until July 2021, 147 had NOAF, and 1617 had normal sinus rhythm. Univariate and multivariate Logistic regressions were employed accordingly to evaluate NOAF risk factors. The statistical assessments have been run utilizing SPSS 25.0 (SPSS) or R 3.6.3 software. Results: For the NOAF patients, the age was significantly higher, and the more prevalent comorbidities were metabolic syndrome, heart failure (HF), peripheral vascular disease, coronary artery disease, and liver cirrhosis. The multivariate analysis showed the established independent risk factors were; Troponin-I (hazard ratio [HR] = 3.86; 95% confidence interval [CI] = 1.89-7.87; p < 0.001), HF (HR = 2.54; 95% CI = 1.61-4.02; p < 0.001), bilateral grand-glass opacification (HR = 2.26; 95% CI = 1.68-3.05; p = 0.002). For cases with thromboembolic events, NOAF was the most important prognostic factor (odds ratio [OR] = 2.97; 95% CI = 2.03-4.33; p < 0.001). While evaluating the diagnostic ability of prognostic factors in detecting NOAF, Troponin-I (Area under the curve [AUC] = 0.85), C-Reactive Protein (AUC = 0.72), and d-dimer (AUC = 0.65) had the most accurate sensitivity. Furthermore, the Kaplan-Meier curves demonstrated that the survival rates diminished more steeply for patients with NOAF history. Conclusion: In hospitalized COVID-19 patients with NOAF, the risk of thromboembolic events, hospital stay, and fatality are significantly higher. The established risk factors showed that patients with older age, higher inflammation states, and more severe clinical conditions based on CHADS2VASC-score potentially need subsequent preventive strategies. Appropriate prophylactic anticoagulants, Initial management of cytokine storm, sufficient oxygen support, and reducing viral shedding could be of assistance in such patients.
Background and Aims: We focused on determining the risk factors, thromboembolic events, and clinical course of New-Onset Atrial Fibrillation (NOAF) among hospitalized coronavirus disease (COVID-19) patients. Methods: This retrospective study was conducted in the major referral centers in Tehran, Iran. Of 1764 patients enrolled in the study from January 2020 until July 2021, 147 had NOAF, and 1617 had normal sinus rhythm. Univariate and multivariate Logistic regressions were employed accordingly to evaluate NOAF risk factors. The statistical assessments have been run utilizing SPSS 25.0 (SPSS) or R 3.6.3 software. Results: For the NOAF patients, the age was significantly higher, and the more prevalent comorbidities were metabolic syndrome, heart failure (HF), peripheral vascular disease, coronary artery disease, and liver cirrhosis. The multivariate analysis showed the established independent risk factors were; Troponin-I (hazard ratio [HR] = 3.86; 95% confidence interval [CI] = 1.89-7.87; p < 0.001), HF (HR = 2.54; 95% CI = 1.61-4.02; p < 0.001), bilateral grand-glass opacification (HR = 2.26; 95% CI = 1.68-3.05; p = 0.002). For cases with thromboembolic events, NOAF was the most important prognostic factor (odds ratio [OR] = 2.97; 95% CI = 2.03-4.33; p < 0.001). While evaluating the diagnostic ability of prognostic factors in detecting NOAF, Troponin-I (Area under the curve [AUC] = 0.85), C-Reactive Protein (AUC = 0.72), and d-dimer (AUC = 0.65) had the most accurate sensitivity. Furthermore, the Kaplan-Meier curves demonstrated that the survival rates diminished more steeply for patients with NOAF history. Conclusion: In hospitalized COVID-19 patients with NOAF, the risk of thromboembolic events, hospital stay, and fatality are significantly higher. The established risk factors showed that patients with older age, higher inflammation states, and more severe clinical conditions based on CHADS2VASC-score potentially need subsequent preventive strategies. Appropriate prophylactic anticoagulants, Initial management of cytokine storm, sufficient oxygen support, and reducing viral shedding could be of assistance in such patients.
Authors: Gordon Chu; Henri H Versteeg; Arie J Verschoor; Serge A Trines; Martin E W Hemels; Cihan Ay; Menno V Huisman; Frederikus A Klok Journal: Blood Rev Date: 2019-03-25 Impact factor: 8.250
Authors: Cornelis S van der Hooft; Jan Heeringa; Guy G Brusselle; Albert Hofman; Jacqueline C M Witteman; J Herre Kingma; Miriam C J M Sturkenboom; Bruno H Ch Stricker Journal: Arch Intern Med Date: 2006-05-08
Authors: Francesco Violi; Roberto Cangemi; Marco Falcone; Gloria Taliani; Filippo Pieralli; Vieri Vannucchi; Carlo Nozzoli; Mario Venditti; Julio A Chirinos; Vicente F Corrales-Medina Journal: Clin Infect Dis Date: 2017-06-01 Impact factor: 9.079