Incidence, Predictors and Outcomes of New-onset Atrial Fibrillation in Critically Ill Patients with Sepsis: a Cohort Study.
Am J Respir Crit Care Med. 2016 Jul 28;
Authors: Klein Klouwenberg PM, Frencken JF, Kuipers S, Ong DS, Peelen LM, van Vught LA, Schultz MJ, van der Poll T, Bonten MJ, Cremer OL, MARS consortium
RATIONALE: Patients admitted to intensive care units with sepsis are prone to developing cardiac dysrhythmias, most commonly atrial fibrillation.
OBJECTIVES: We determined the incidence, risk factors and outcomes of atrial fibrillation in a cohort of critically ill patients with sepsis.
METHODS: We assessed the association between atrial fibrillation and mortality using time-dependent competing risks survival analysis. Subsequently, for development of a risk score estimating the probability of a first occurrence of atrial fibrillation within the following 24 hours, we performed logistic regression analysis.
MEASUREMENTS AND MAIN RESULTS: Among 1,782 patients with sepsis admitted to two tertiary intensive care units in the Netherlands between January 2011 and June 2013, a total of 1,087 episodes of atrial fibrillation occurred in 418 (23%) individuals. The cumulative risk of new-onset atrial fibrillation was 10% (95% CI 8-12), 22% (95% CI 18-25), 40% (95% CI 36-44) in patients with sepsis, severe sepsis and septic shock, respectively. New-onset atrial fibrillation was associated with a longer stay (HR 0.55; 95% CI 0.48-0.64), an increased death rate (HR 1.52; 95% CI 1.16-2.00), and an overall increased mortality risk (subdistribution HR 2.10; 95% CI 1.61-2.73) when considering discharge as a competing event. A simple risk score for daily prediction of atrial fibrillation occurrence yielded good discrimination (c-statistic 0.81; 95% CI 0.79-0.84) and calibration (χ2= 9.38; P .31), with similar performance in an independent validation cohort (c-statistic 0.80; 95% CI 0.76-0.85).
CONCLUSIONS: Atrial fibrillation is a common complication of sepsis and independently associated with excess mortality. A simple risk score may identify patients at high risk of this complication.
PMID: 27467907 [PubMed - as supplied by publisher]