New-Onset Atrial Fibrillation in Patients Undergoing Liver Transplantation: Retrospective Analysis of Risk Factors and Outcomes.
J Cardiothorac Vasc Anesth
; 36(11): 4100-4107, 2022 11.
Article
in En
| MEDLINE
| ID: mdl-35999113
ABSTRACT
OBJECTIVE:
The authors aimed to identify predictors of new-onset postoperative atrial fibrillation (POAF) during the initial 90 days following liver transplantation, and to assess the association between POAF in-hospital and 1-year mortality.DESIGN:
A retrospective cohort study.SETTING:
At a university hospital between 2005 and 2017. PATIENTS Adults without a history of preoperative atrial fibrillation who underwent orthotopicliver transplantation. MEASUREMENT AND MAINRESULTS:
The authors assessed the univariate association between new-onset of POAF in the postoperative period and each potential factor through a logistic regression model. Moreover, they explored predictors for POAF through stepwise selection. Finally, the authors assessed the relationship between POAF and in-hospital and 1-year mortality using logistic regression models, and whether the duration of atrial fibrillation was associated with in-hospital and 1-year mortality. Among 857 patients, 89 (10.4%) developed POAF. Using only preoperative variables, pulmonary hypertension, age, Model for End-Stage Liver Disease (MELD) score, and White race were identified as the most important predictors. Model discrimination was 0.75 (95% CI 0.69-0.80), and incorporating intraoperative variables was 0.77 (95% CI 0.72-0.82). In-hospital mortality was observed in 7.2% (6/83) of patients with new-onset of POAF, and in 2.8% (22/768) without, with confounder-adjusted odds ratio (OR) 1.00 (97.5% CI 0.29,3.45; p = 0.996). One-year mortality was 22.4% (20/89) in patients who developed POAF and 8.3% (64/768) in patients who did not, confounder-adjusted OR 2.64 (97.5% CI 1.35-5.16; p = 0.001). The duration of POAF did not affect long-term postoperative mortality.CONCLUSION:
Preoperative, mostly unmodifiable comorbidities are important risk factors for new-onset POAF after liver transplantation. The POAF was not associated with in-hospital mortality, but with increased 1-year mortality. Once developed, the duration of POAF did not affect long-term mortality after a liver transplant.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Atrial Fibrillation
/
Liver Transplantation
/
End Stage Liver Disease
Type of study:
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Adult
/
Humans
Language:
En
Journal:
J Cardiothorac Vasc Anesth
Journal subject:
ANESTESIOLOGIA
/
CARDIOLOGIA
Year:
2022
Document type:
Article
Affiliation country:
Spain