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Volume 40 Issue 9
Sep.  2024
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Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  > 2024  >  40(9): 857-865
Jiang NH,Xie WG,Wang DY,et al.Analysis of risk factors for atrial fibrillation in adult patients with critically severe burns after the first surgery[J].Chin J Burns Wounds,2024,40(9):857-865.DOI: 10.3760/cma.j.cn501225-20240329-00111.
Citation: Jiang NH,Xie WG,Wang DY,et al.Analysis of risk factors for atrial fibrillation in adult patients with critically severe burns after the first surgery[J].Chin J Burns Wounds,2024,40(9):857-865.DOI: 10.3760/cma.j.cn501225-20240329-00111.
shu

Analysis of risk factors for atrial fibrillation in adult patients with critically severe burns after the first surgery

doi: 10.3760/cma.j.cn501225-20240329-00111

  • Department of Burns, Tongren Hospital of Wuhan UniversityWuhan Third Hospital, Wuhan 430060, China

Funds:

Action Plan for Science and Technology in Major Disease Prevention and Control 2018-ZX-01S-001

Medical Scientific Research Projects of Wuhan Municipal Health Commission WX23Z02

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  • Corresponding author: Xie Weiguo, Email: wgxie@hotmail.com
  • Received Date: 2024-03-29
    Abstract
  •   Objective  To explore the risk factors for atrial fibrillation in adult patients with critically severe burns after the first surgery.  Methods  This study was a retrospective case series study. From January 1, 2018 to March 31, 2023, 211 adult patients with critically severe burns were admitted to the Department of Burns of Tongren Hospital of Wuhan University & Wuhan Third Hospital and met the inclusion criteria, including 158 males and 53 females, aged 24-81 years. According to whether atrial fibrillation occurred after the first surgery, the patients were divided into postoperative atrial fibrillation (POAF) group (23 cases) and non-POAF group (188 cases). The following indexes of patients in POAF group were collected, including the onset time, duration, treatment method, and number of patients with more than once of atrial fibrillation after the first surgery. The following data of the two groups of patients were collected, including general data, such as gender, age, burn type, total burn area, full-thickness burn area, inhalation injury, underlying diseases, mechanical ventilation, and sepsis; electrolyte imbalance and blood index level before the first surgery; the first surgery-related information such as surgical length and surgical method; volume changes and vital signs during the first surgery, such as total volume of fluid infusion, total volume of blood transfusion, volume of blood loss, hypotension, and hypothermia; postoperative hypothermia; inflammatory index levels before the first surgery and on the first day after the first surgery, such as procalcitonin levels, white blood cell count, neutrophil count, lymphocyte count, platelet count, neutrophil to lymphocyte ratio (NLR), platelet count to lymphocyte ratio (PLR); mortality within 30 days of admission. The independent risk factors for occurrence of atrial fibrillation in adult patients with critically severe burns after the first surgery were screened.  Results  The onset time of atrial fibrillation of patients in POAF group was 2 (2, 4) hours after the first surgery, and the duration of atrial fibrillation was 16 (6, 26) hours. Twenty-one patients were treated with intravenous injection of amiodarone, two patients were treated with cardiac electrical cardioversion, and atrial fibrillation of all patients converted to sinus rhythm after treatment. Three patients experienced atrial fibrillation more than once. The age was 59 (42, 70) years and the total burn area was 90% (70%, 94%) total body surface area (TBSA) in patients in POAF group, which were significantly higher than 48 (38, 56) years and 70% (60%, 83%) TBSA in non-POAF group (with Z values of -2.64 and -3.56, respectively, P<0.05). Compared with those in non-POAF group, the incidence rate of inhalation injury of patients in POAF group was significantly higher (χ2=4.45, P<0.05), the total volumes of fluid infusion and blood transfusion during the first surgery were significantly increased (with Z values of -3.98 and -3.75, respectively, P<0.05), the incidence rates of hypothermia during the first surgery and hypothermia after the first surgery were significantly increased (with χ2 values of 8.24 and 18.72, respectively, P<0.05), the levels of procalcitonin before the first surgery and on the first day after the first surgery, as well as the NLR on the first day after the first surgery were significantly increased (with Z values of -3.03, -2.19, and -2.18, respectively, P<0.05), the lymphocyte count (with Z values of -2.07 and -2.60, respectively, P<0.05) and platelet count (with Z values of -3.35 and -3.58, respectively, P<0.05) were significantly reduced before the first surgery and on the first day after the first surgery, and the mortality rate within 30 days of admission was significantly higher (χ2=4.03, P<0.05). There were no statistically significant differences in other indexes between the two groups of patients (P>0.05). Multivariate logistic regression analysis showed that age, total burn area, and intraoperative hypothermia were independent risk factors for the occurrence of atrial fibrillation in adult patients with critically severe burns after the first surgery (with odds ratios of 1.08, 1.07, and 4.18, 95% confidence intervals of 1.03-1.12, 1.03-1.11, and 1.48-11.80, respectively, P<0.05).  Conclusions  Age, total burn area, and intraoperative hypothermia are independent risk factors for the occurrence of atrial fibrillation in adult patients with critically severe burns after the first surgery. Patients with atrial fibrillation have an increased risk of death.

     

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    • References(40)
  • [1]
    WuG,WuJ,LuQ,et al.Association between cardiovascular risk factors and atrial fibrillation[J].Front Cardiovasc Med,2023,10:1110424.DOI: 10.3389/fcvm.2023.1110424.
    [2]
    SureshMR,MillsAC,BrittonGW,et al.Initial treatment strategies in new-onset atrial fibrillation in critically ill burn patients[J].Int J Burns Trauma,2022,12(6):251-260.
    [3]
    LinMH,KamelH,SingerDE,et al.Perioperative/postoperative atrial fibrillation and risk of subsequent stroke and/or mortality[J].Stroke,2019,50(6):1364-1371.DOI: 10.1161/STROKEAHA.118.023921.
    [4]
    GaudinoM,Di FrancoA,RongLQ,et al.Postoperative atrial fibrillation: from mechanisms to treatment[J].Eur Heart J,2023,44(12):1020-1039.DOI: 10.1093/eurheartj/ehad019.
    [5]
    BernalE,WolfS,CrippsM.New-onset, postoperative tachyarrhythmias in critically ill surgical patients[J].Burns,2018,44(2):249-255.DOI: 10.1016/j.burns.2017.06.012.
    [6]
    BjerrumE,WahlstroemKL,GögenurI,et al.Postoperative atrial fibrillation following emergency noncardiothoracic surgery: a systematic review[J].Eur J Anaesthesiol,2020,37(8):671-679.DOI: 10.1097/EJA.0000000000001265.
    [7]
    BessissowA,KhanJ,DevereauxPJ,et al.Postoperative atrial fibrillation in non-cardiac and cardiac surgery: an overview[J].J Thromb Haemost,2015,13Suppl 1:S304-312.DOI: 10.1111/jth.12974.
    [8]
    JiangS,LiaoX,ChenY,et al.Exploring postoperative atrial fibrillation after non-cardiac surgery: mechanisms, risk factors, and prevention strategies[J].Front Cardiovasc Med,2023,10:1273547.DOI: 10.3389/fcvm.2023.1273547.
    [9]
    陈宾,汤文彬,李孝建,等.危重烧伤并发术后心房颤动患者的临床特征及其危险因素分析[J].中华烧伤与创面修复杂志,2022,38(5):408-414.DOI: 10.3760/cma.j.cn501225-20220214-00026.
    [10]
    HuY,OuS,FengQ,et al.Incidence and predictors of perioperative atrial fibrillation in burn intensive care unit patients following burn surgery[J].Burns,2022,48(5):1092-1096.DOI: 10.1016/j.burns.2022.04.012.
    [11]
    IyahGR,ReddyPC,El-AminO,et al.Electrocardiographic abnormalities in patients with acute burn injuries[J].J La State Med Soc,2008,160(1):39-40, 42-43.
    [12]
    YoshidaT,UchinoS,SasabuchiY,et al.Prognostic impact of sustained new-onset atrial fibrillation in critically ill patients[J].Intensive Care Med,2020,46(1):27-35.DOI: 10.1007/s00134-019-05822-8.
    [13]
    YoshidaT,UchinoS,YokotaT,et al.The impact of sustained new-onset atrial fibrillation on mortality and stroke incidence in critically ill patients: a retrospective cohort study[J].J Crit Care,2018,44:267-272.DOI: 10.1016/j.jcrc.2017.11.040.
    [14]
    BrownM,NassoiyS,ChaneyW,et al.Impact and treatment success of new-onset atrial fibrillation with rapid ventricular rate development in the surgical intensive care unit[J].J Surg Res,2018,229:66-75.DOI: 10.1016/j.jss.2018.03.009.
    [15]
    GoAS,HylekEM,PhillipsKA,et al.Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the an ticoagulation and risk factors in atrial fibrillation (ATRIA) study[J].JAMA,2001,285(18):2370-2375.DOI: 10.1001/jama.285.18.2370.
    [16]
    HindricksG,PotparaT,DagresN,et al.2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC[J].Eur Heart J,2021,42(5):373-498.DOI: 10.1093/eurheartj/ehaa612.
    [17]
    GaitaF,FerrarisF,AnselminoM,et al.Atrial fibrillation fundamentals: from physiopathology to transcatheter ablation[J].Eur Heart JSuppl,2023,25(Suppl C):C7-C11.DOI: 10.1093/eurheartjsupp/suad003.
    [18]
    RaniM,SchwachaMG.Aging and the pathogenic response to burn[J].Aging Dis,2012,3(2):171-180.
    [19]
    LeventopoulosG,KorosR,TravlosC,et al.Mechanisms of atrial fibrillation: how our knowledge affects clinical practice[J].Life (Basel),2023,13(6):1260.DOI: 10.3390/life13061260.
    [20]
    李一,张莉,刘军,等.脉搏轮廓心排血量监测技术在大面积烧伤患者早期补液时对心肌损害的影响[J].中华烧伤杂志,2019,35(8):574-579.DOI: 10.3760/cma.j.issn.1009-2587.2019.08.004.
    [21]
    SibleyS,MuscedereJ.New-onset atrial fibrillation in critically ill patients[J].Can Respir J,2015,22(3):179-182.DOI: 10.1155/2015/394961.
    [22]
    DanelichIM,LoseJM,WrightSS,et al.Practical management of postoperative atrial fibrillation after noncardiac surgery[J].J Am Coll Surg,2014,219(4):831-841.DOI: 10.1016/j.jamcollsurg.2014.02.038.
    [23]
    ChelazziC,VillaG,De GaudioAR.Postoperative atrial fibrillation[J].ISRN Cardiol,2011,2011:203179.DOI: 10.5402/2011/203179.
    [24]
    WongyingsinnM,PookprayoonV.Incidence and associated factors of perioperative hypothermia in adult patients at a university-based, tertiary care hospital in Thailand[J].BMC Anesthesiol,2023,23(1):137.DOI: 10.1186/s12871-023-02084-2.
    [25]
    FilippiS,GizziA,CherubiniC,et al.Mechanistic insights into hypothermic ventricular fibrillation: the role of temperature and tissue size[J].Europace,2014,16(3):424-434.DOI: 10.1093/europace/euu031.
    [26]
    WangYC,HuangHH,LinPC,et al.Hypothermia is an independent risk factor for prolonged ICU stay in coronary artery bypass surgery: an observational study[J].Sci Rep,2023,13(1):4626.DOI: 10.1038/s41598-023-31889-x.
    [27]
    Recio-PérezJ,Miró MurilloM,Martin MesaM,et al.Effect of prewarming on perioperative hypothermia in patients undergoing loco-regional or general anesthesia: a randomized clinical trial[J].Medicina (Kaunas),2023,59(12):2082.DOI: 10.3390/medicina59122082.
    [28]
    KleimeyerJP,HarrisAHS,SanfordJ,et al.Incidence and risk factors for postoperative hypothermia after orthopaedic surgery[J].J Am Acad Orthop Surg,2018,26(24):e497-e503.DOI: 10.5435/JAAOS-D-16-00742.
    [29]
    LiL,LuY,YangLL,et al.Construction and validation of postoperative hypothermia prediction model for patients undergoing joint replacement surgery[J].J Clin Nurs,2023,32(13/14):3831-3839.DOI: 10.1111/jocn.16503.
    [30]
    RajagopalanS,MaschaE,NaJ,et al.The effects of mild perioperative hypothermia on blood loss and transfusion requirement[J].Anesthesiology,2008,108(1):71-77.DOI: 10.1097/01.anes.0000296719.73450.52.
    [31]
    HuY,TianY,ZhangM,et al.Study of risk factors for intraoperative hypothermia during pediatric burn surgery[J].World J Pediatr Surg,2021,4(1):e000141.DOI: 10.1136/wjps-2020-000141.
    [32]
    古兰,王玲,苗文,等.综合保温措施对大面积烧伤切痂植皮术患者围手术期治疗效果的影响[J].中华烧伤杂志,2020,36(11):1060-1064.DOI: 10.3760/cma.j.cn501120-20191218-00461.
    [33]
    LucaE,SchipaC,CambiseC,et al.Implication of age-related changes on anesthesia management[J].Saudi J Anaesth,2023,17(4):474-481.DOI: 10.4103/sja.sja_579_23.
    [34]
    SalehiH, MoienianE, RahbarA, et al. Prevalence of thrombocytopenia in the first week after burn injury and its relationship with burn severity in Shahid Motahari Hospital over a period of 6 months in 2017[J]. Ann Burns Fire Disasters, 2023,36(1):29-39.
    [35]
    ShaoQ,ChenK,RhaSW,et al.Usefulness of neutrophil/lymphocyte ratio as a predictor of atrial fibrillation: a meta-analysis[J].Arch Med Res,2015,46(3):199-206.DOI: 10.1016/j.arcmed.2015.03.011.
    [36]
    GuanYZ,YinRX,ZhengPF,et al.Association of RDW, NLR, and PLR with atrial fibrillation in critical care patients: a retrospective study based on propensity score matching[J].Dis Markers,2022,2022:2694499.DOI: 10.1155/2022/2694499.
    [37]
    ChenC,TangX,FanP.Platelet-to-lymphocyte ratio as an independent factor associated with atrial tachyarrhythmia[J].Cureus,2023,15(10):e46775.DOI: 10.7759/cureus.46775.
    [38]
    QiuL,JinX,WangJJ,et al.Plasma neutrophil-to-lymphocyte ratio on the third day postburn is associated with 90-day mortality among patients with burns over 30% of total body surface area in two Chinese burns centers[J].J Inflamm Res,2021,14:519-526.DOI: 10.2147/JIR.S294543.
    [39]
    SivriF,GüngörH,ÇokpınarS,et al.Value of preoperative platelet-to-lymphocyte and neutrophil-to-lymphocyte ratios in predicting postoperative atrial fibrillation in patients undergoing lung resection[J].J Tehran Heart Cent,2022,17(4):236-242.DOI: 10.18502/jthc.v17i4.11613.
    [40]
    ÖmürSE, ZorluÇ, YılmazM.Comparison of the relationship between inflammatory markers and atrial fibrillation burden[J].Anatol J Cardiol,2023,27(8):486-493.DOI: 10.14744/AnatolJCardiol.2023.2927.
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