Clinical Characteristics And In-hospital Mortality Risk Factors In Cirrhotic Patients With Atrial Arrhythmias

Objective : To analyze the clinical characteristics of cirrhotic patients with atrial arrhythmias.To investigate the risk factors associated with in-hospital mortality in cirrhotic patients with atrial arrhythmias.Methods:A total of 252 consecutive patients hospitalized with cirrhosis and atrial arrhythmia between January 2014 and December2021 were included and their clinical characteristics were analyzed,in addition,the patients were grouped according to the above-mentioned in-hospital deaths,of whom 45 were classified into the death group;207 patients survived and were classified into the survival group.Clinical data as well as laboratory data were compared between the two groups to analyze the risk factors for in-hospital death in cirrhotic patients with atrial arrhythmias,statistical analysis was performed using SPSS software,and the t-test or rank sum test was used to compare the measurement data,χ2 or Fisher’s exact probability method was used to compare count data.Multivariate analysis was performed using logistic regression.Results:The 252 patients had the same male to female ratio(126 / 126 male / female),26-89(66.77 ± 10.46),79.5% were of Han ethnicity,The type of atrial arrhythmia was dominated by atrial fibrillation(175 patients with atrial fibrillation only present,38 patients with atrial fibrillation combined with atrial tachycardia,7 patients with atrial fibrillation combined with atrial flutter,9 patients with atrial fibrillation combined with atrial extrasystole only present,7 patients with atrial extrasystole only present,and 16 patients with atrial tachycardia only present).The etiology of cirrhosis was mainly post hepatitis B cirrhosis(36.9%),with 57 / 72 / 123 patients having CTP grade A / B / C,10.30 ± 1.77,20.62 ± 11.12 having CTP and MELD scores,respectively(total bilirubin,albumin,alanine aminotransferase,aspartate aminotransferase,platelet,prothrombin activity,B-type natriuretic peptide(BNP),113.13 ± 142.39 μmol / L,(30.77 ± 6.05)g / L,(53.22 ± 106.76)U / L,(41.31 ± 21.73)U / L,(91.43 ± 70.19)x 109 / L,(43.53 ± 26.64)%and(4845.14 ± 10337.22)ng / L,respectively,and the in-hospital mortality rate was17.9%(45 / 252).The overall complication rate of all patients was 89.28%,and the complication rates were,in order,abdominal effusion(71.4%),hypersplenism(71.0%),spontaneous peritonitis(64.7%),esophageal gastric varices(64.3%)%),hepatorenal syndrome(32.5%),hepatic encephalopathy(32.1%),pulmonary infection(29.8%),esophageal gastric variceal bleeding(26.2%),sepsis(17.5%),and septic shock(9.9%).In the analysis of risk factors for in-hospital mortality,univariate analysis showed that the two groups were significantly different in terms of type of atrial arrhythmia,depth of pleural fluid,serum potassium,TT,D-dimer,fibrinogen,APTT,Pt,PTA,INR,BNP,hemoglobin,red blood cell,platelet count,alt,AST,total protein,globulin,total bilirubin,child Pugh score,MELD score,interleukin-6,CRP,urea nitrogen,creatinine,direct bilirubin and other laboratory parameters,There were differences in terms of complications including re spontane ous peritonitis,hypersplenism,esophageal gastric variceal bleeding,hepatic encephalopathy,hepatorenal syndrome,esophageal gastric varices,and left atrial enlargement(P < 0.05).Multiple logistic regression analysis showed that paroxysmal AF(or = 2.707,95% CI 1.119-6.549),esophago gastric varices(or = 3.287,95% CI 1.189-9.085),serum potassium(or = 3.820,95% CI 1.532-9.526),MELD score(or = 1.108,95% CI 1.061-1.157)were independent risk factors for in-hospital mortality in cirrhotic patients with atrial arrhythmias.Conclusion:Patients with cirrhosis and atrial arrhythmias have more serious hepatic impairment,and they are more likely to develop complications such as peritoneal effusion,hypersplenism,hepatorenal syndrome,paroxysmal AF,esophageal gastric varices,high serum potassium level,and high MELD score as risk factors for in-hospital mortality in patients with cirrhosis and atrial arrhythmias,and should pay more attention to the corresponding patients and prompt symptomatic management.