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©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Mortality and morbidity in patients with atrial fibrillation and liver cirrhosis
Yousef H Darrat, Aiman Smer, Claude-Samy Elayi, Gustavo X Morales, Fahad Alqahtani, Mohamad Alkhouli, John Catanzaro, Jignesh Shah, Mohsin Salih
Yousef H Darrat, Department of Internal Medicine, Veterans Affairs Medical Center, Lexington, KY 40515, United States
Aiman Smer, Department of Internal Medicine, Creighton University, Omaha, NE 68178, United States
Claude-Samy Elayi, John Catanzaro, Department of Internal Medicine, University of Florida, Jacksonville, FL 32211, United States
Gustavo X Morales, Cardiac Electrophysiology, Grandview Medical Center, Birmingham, AL 35243, United States
Fahad Alqahtani, Department of Internal Medicine, University of Kentucky, Lexington, KY 40536, United States
Mohamad Alkhouli, Department of Internal Medicine, West Virginia University, Morgantown, WV 26506, United States
Jignesh Shah, Cardiac Electrophysiology, Boulder Heart, Boulder, CO 80303, United States
Mohsin Salih, Department of Internal Medicine, University of Southern Illinois, Springfield, IL 62702, United States
Author contributions: Salih M designed the research; Darrat YH, Elayi CS, and Morales GX wrote the paper; Smer A, Catanzaro J, and Shah J performed research; Alqahtani F and Alkhouli M analyzed the data; all authors contributed to this paper.
Institutional review board statement: The National (Nationwide) Inpatient Sample is a large publicly available all-payer inpatient care database in the United States. Since it is publicly available and patient data is de-identified, an institutional review board approval was not required.
Informed consent statement: The National (Nationwide) Inpatient Sample is a large publicly available all-payer inpatient care database in the United States. Since it is publicly available and there was no patient interaction, informed consent was not obtained.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yousef H Darrat, MD, Attending Physician, Department of Internal Medicine, Veterans Affairs Medical Center, 1101 Veterans Drive, Lexington, KY 40502, United States.
ydarat@hotmail.com
Received: January 30, 2020
Peer-review started: January 30, 2020
First decision: March 24, 2020
Revised: May 10, 2020
Accepted: May 29, 2020
Article in press: May 29, 2020
Published online: July 26, 2020
Processing time: 176 Days and 10.7 Hours
BACKGROUND
Atrial fibrillation (AF) is the most common cardiac arrhythmia encountered in clinical practice. However, the outcomes associated with AF in hospitalized patients with liver cirrhosis are unknown.
AIM
To determine the outcomes of hospitalized patients with liver cirrhosis and AF.
METHODS
In this study, we examined morbidity and mortality of patients with concomitant AF and liver cirrhosis from the National Inpatient Sample database, the largest publicly available inpatient healthcare database in the United States.
RESULTS
A total of 696937 patients with liver cirrhosis were included, 45745 of whom had concomitant AF (6.6%). Liver cirrhosis patients with AF had higher rates of in-hospital mortality (12.6% vs 10.3%, P < 0.001), clinical stroke (1.6% vs 1.1%, P < 0.001), and acute kidney injury (28.2% vs 25.1%, P < 0.001), and less gastrointestinal bleeding (4.4% vs 5.1%, P < 0.001) and blood transfusion (22.5% vs 23.8%, P < 0.001) compared with those who did not have the arrhythmia. In addition, they had a longer length of stay (8 ± 10 d vs 7 ± 8 d, P < 0.001) and higher hospitalization costs (20720 ± 33210 $ vs 16272 ± 24166 $, P < 0.001).
CONCLUSION
In subjects with liver cirrhosis, AF is associated with higher rates of inpatient mortality, stroke, and acute kidney injury compared to those who do not have the cardiac arrhythmia.
Core tip: Atrial fibrillation is an adverse prognostic indicator in patients with liver cirrhosis. It is associated with increased inpatient mortality and a higher risk of cerebrovascular attack and renal failure. Furthermore, it leads to a longer hospital stay and admission to an acute care or a rehabilitation facility in this patient population.
