Pneumonia as a trigger for atrial fibrillation

Risk factors, thromboembolic events, and clinical course of New-Onset Atrial Fibrillation among COVID-19 hospitalized patients: A multicenter cross-sectional analysis in Iran

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.

Clinical manifestation, laboratory and radiology finding, treatment and outcomes of COVID-19: A systematic review and meta-analysis

BACKGROUND

Since December 2019, coronavirus (COVID-19) spread throughout the world. The high rate of infection and its unknown nature led specialists to report the condition of patients. The aim of this study is to systematically review of symptoms, laboratory and radiologic findings, treatment, and outcomes of patients with COVID-19.

MATERIALS AND METHODS

Databases such as PubMed, Embase, Scopus, Web of Science, Google Scholar, and Cochrane were searched. Finally, 46 articles were appropriate for the aim of the study. After quality evaluation, the necessary data were extracted and meta-analysis was performed.

RESULTS

4858 articles were retrieved until March 30, 2020. After screening, the full-text of 46 articles was assessed. Of the reported cases, 31.7% had no comorbidities, 21.4% had high blood pressure, 70.6% had fever, and lymphopenia was reported in 55.2% of patients. For 16% bilateral patchy shadowing in radiography and for 51% ground-glass opacity was reported. Outcomes were remarkable for recover to death.

CONCLUSION

COVID-19 leads to healthcare problems for countries. Nonspecific symptoms have made it difficult for differential diagnoses without computed tomography-scan or corona Test, but they are not available in many countries. Therefore, this systematic review can help health care staff to make decisions based on symptoms, treatments, and outcomes..

New onset atrial fibrilation and risk faktors in COVID-19

BACKGROUND

There is limited data concerning the prevalence of arrhythmias, particularly atrial fibrillation (AF), which may develop as a consequence of direct myocardial injury and the inflammatory state existing in COVID-19.

METHODS

This single-center study included data concerning 658 COVID-19 patients, who were hospitalized in our institute, between April 20th, 2020 and July 30th, 2020. Demographic data, findings of the imaging studies, and laboratory test results were retrieved from the institutional digital database.

RESULTS

New onset AF (NOAF) was identified in 33 patients (5%). Patients who developed AF were older (72.42 ± 6.10 vs 53.78 ± 13.80, p < 0.001) and had higher frequencies of hypertension and heart failure compared to patients without NOAF (p < 0.001, for both). The CHA2DS2-VASc score was higher in patients, who developed NOAF, compared to those who did not during hospitalization for COVID-19 (p < 0.001). Subjects, who developed NOAF during hospitalization, had a higher leukocyte count, neutrophil / lymphocyte ratio (NLR), C-reactive protein, erythrocyte sedimentation rate, and procalcitonin levels compared to those without NOAF (p < 0.001 for all comparisons). Diffuse lung infiltration was also more frequent in COVID-19 patients, who developed NOAF, during hospitalization (p = 0.015). Multivariate logistic regression analysis demonstrated that age, CHA2DS2-VASc score, CRP, erythrocyte sedimentation rate, and presence of diffuse lung infiltration on thorax CT were predictive for NOAF.

CONCLUSION

The prevalence of NOAF in hospitalized COVID-19 patients is higher than the general population. Age, CHA2DS2-VASc score, C-reactive protein, erythrocyte sedimentation rate, and presence of diffuse lung infiltration on thorax CT may be used to identify patients at high risk for development of NOAF. Especially among these parameters, the presence of diffuse lung infiltration on thorax CT it was the most powerful independent predictor of NOAF development.