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Am J Respir Crit Care Med. 2017 Jan 15;195(2):205-211. doi: 10.1164/rccm.201603-0618OC.

Incidence, Predictors, and Outcomes of New-Onset Atrial Fibrillation in Critically Ill Patients with Sepsis. A Cohort Study.

Author information

1
1 Department of Intensive Care Medicine.
2
2 Department of Medical Microbiology, and.
3
3 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands; and.
4
4 Center for Experimental and Molecular Medicine, Division of Infectious Diseases, and.
5
5 Department of Intensive Care, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.

Abstract

RATIONALE:

Patients admitted to intensive care units with sepsis are prone to developing cardiac dysrhythmias, most commonly atrial fibrillation.

OBJECTIVES:

To determine 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% confidence interval [CI], 8-12), 22% (95% CI, 18-25), and 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 (hazard ratio [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 (chi-square, 9.38; Pā€‰=ā€‰0.31), 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. Clinical trial registered with www.clinicaltrials.gov (NCT 01905033).

KEYWORDS:

atrial fibrillation; epidemiology; intensive care unit; mortality; risk factors

PMID:
27467907
DOI:
10.1164/rccm.201603-0618OC
[Indexed for MEDLINE]

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