Published ahead of print on April 3, 2008, doi:10.1164/rccm.200701-031OC Am. J. Respir. Crit. Care Med., Volume 178, Number 1, July 2008, 20-25 A more recent version of this article appeared on July 1, 2008
Submitted on January 5, 2007 Incidence and Prognosis of Sustained Arrhythmias in Critically Ill PatientsDjillali Annane1*,1 The Service de Reanimation Medicale, Hopital Raymond Poincare, Assistance Publique-Hopitaux de Paris, Faculte de Medecine Paris Ile de France Ouest, Universite de Versailles Saint-Quentin en Yvelines, Garches, France, 2 Laboratorie de Biostatistiques, Faculte de Pharmacie, Universite de Nantes, Nantes, France, 3 Service de Cardiologie, Hopital Cochin, Assistance Publique-Hopitaux de Paris, Universite Paris V, Paris, France, 4 Service de Cardiologie, Hopital Europeen Georges Pompidou, Assistance Publique-Hopitaux de Paris, Universite Paris V, Paris, France, 5 Service de Cardiologie, Hopital Brabois Centre Hospitalier Universitaire, Universite de Nancy I, Vandoeuvre Les Nancy, France, 6 Centre d'Investigation Clinique INSERM 0203, Unite de Pharmacologie Clinique, Service de Pharmacologie, Hopital de Pontchaillou, Centre Hospitalier Universitaire, Faculte de Medecine, Universite de Rennes 1, Rennes, France * To whom correspondence should be addressed. E-mail: djillali.annane{at}rpc.aphp.fr.
Rationale: Sustained arrhythmias are common in postoperative and cardiac intensive care units (ICUs), but their incidence and prognosis in general ICUs have never been reported. Objective: To estimate the incidence and prognosis of sustained arrhythmias in a general ICU population. Methods: Prospective, multicenter, 1-month inception cohort study. Measurements and main results: One thousand three hundred and forty one patients were included: 12% (163/1341) had sustained arrhythmias, including 8% (113/1341) and 2% (30/1341) with supraventricular and ventricular arrhythmias, respectively, and 2% (30/1341) with conduction abnormalities. In-hospital death rates were 17% (205/1178) in patients without arrhythmia and 29% (33/113) in patients with supraventricular arrhythmias (odds ratio [OR]=1.95; 95% confidence interval [CI]: 1.27-3.01), 73% (22/30) in patients with ventricular arrhythmias (OR=13.20; 95% CI: 5.79-30.10), and 60% (18/30) in patients with conduction abnormalities (OR=7.46; 95% CI: 3.52-15.82). Neurological sequels rates were 6% (55/973) in arrhythmia-free survivors, and 15% (12/80) in survivors with supraventricular arrhythmias (OR=2.92; 95% CI: 1.45-5.89), 38% (3/8) in survivors with ventricular arrhythmias (OR=7.53; 95% CI: 1.60-35.50), and 17% (2/12) in survivors with conduction abnormalities (OR=8.77; 95% CI: 1.65-46.57). After adjusting for prognosis factors and propensity scores, ventricular arrhythmias still increased mortality (OR=3.53; 95% CI: 1.19-10.42) but supraventricular arrhythmias and conduction abnormalities did not. Conclusions: Sustained arrhythmias are observed in 12% of patients admitted to general ICUs. Ventricular arrhythmias increase the risk of death. Key words: Arrhythmia, critical illness, hospital mortality, neurological sequel, propensity score.
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