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- Title
PAROXYSMAL ATRIAL FIBRILLATION AND OUTCOME IN CRITICALLY ILL PATIENTS WITH SEPSIS AND/OR SEPTIC SHOCK IN MEDICAL INTENSIVE CARE UNIT, CLINICAL CENTER UNIVERSITY OF SARAJEVO.
- Authors
Aganović, Kenana; Iglica, Amer; Sladić, Irma; Tančica, Ira
- Abstract
Paroxysmal atrial fibrillation (PAF), common arrhythmia in intensive care units, and its effects on outcome in critically ill patients with sepsis and /or septic shock are not fully understood. The objective of this study was to evaluate the outcome in critically ill patients with sepsis and/or septic shock with or without PAF, as well as incidence of PAF in this population and risk factors for its development. Prospective, observational study, during the period of 24 months, included 116 patients in Medical Intensive Care Unit, Clinical Center University of Sarajevo. Patients were included by International Sepsis Definitions Conference criteria, evaluated by severity of illness scores (APACHE II; SAPS II; SOFA) and treated according to Surviving Sepsis Campaign, international guidelines for management of severe sepsis and septic shock. In observed group, 20 patients (17%) developed PAF. Overall mortality was 61%, and mortality was significantly higher in septic shock patients with PAF comparing to septic shock patients without PAF. Hospital length of stay, duration of mechanical ventilation between sepsis/septic shock patients without and with PAF was not statistically significantly different. Systemic inflammatory reaction, as such, was possible trigger for PAF, most probably within septic cardiomyopathy. Comorbidity and age, APACHE II score values, catecholamines, did not influence PAF incidence. However, comparison of survivors and non-survivors groups showed statistically significant difference in relation to age, APACHE II score and number of dysfunctional organs. Multivariate logistic regression analysis showed strong association between severity of illness and atrial fibrillation to lethal outcome. Duration of hypotension, before introducing efficient antimicrobial therapy and overall treatment, was variable which had strongest influence on mortality of patients with septic shock with or without AF. Conclusion: PAF is unlikely to be the mortality risk factor; more likely is epiphenomena, marker of severity of illness. According to that, duration of hypotension has been shown to be the basic predictive independent variable for the lethal outcome. Early recognition, diagnosis of sepsis/septic shock are crucial for early specific treatment in intensive care unit and improving the outcome.
- Subjects
SARAJEVO (Bosnia &; Herzegovina); ATRIAL fibrillation treatment; SEPTICEMIA treatment; PAROXYSMAL hemoglobinuria; INTENSIVE care units; SEPTIC shock; SCIENTIFIC observation; LENGTH of stay in hospitals; HEALTH outcome assessment
- Publication
Medical Journal / Medicinski Žurnal, 2013, Vol 19, Issue 2, p126
- ISSN
1512-5866
- Publication type
Article