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- Title
Incidence, Predictors, and Outcomes of New-Onset Atrial Fibrillation in Critically Ill Patients with Sepsis. A Cohort Study.
- Authors
Klein Klouwenberg, Peter M. C.; Frencken, Jos F.; Kuipers, Sanne; Ong, David S. Y.; Peelen, Linda M.; van Vught, Lonneke A.; Schultz, Marcus J.; van der Poll, Tom; Bonten, Marc J.; Cremer, Olaf L.; MARS Consortium *
- Abstract
<bold>Rationale: </bold>Patients admitted to intensive care units with sepsis are prone to developing cardiac dysrhythmias, most commonly atrial fibrillation.<bold>Objectives: </bold>To determine the incidence, risk factors, and outcomes of atrial fibrillation in a cohort of critically ill patients with sepsis.<bold>Methods: </bold>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.<bold>Measurements and Main Results: </bold>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; P = 0.31), with similar performance in an independent validation cohort (C statistic, 0.80; 95% CI, 0.76-0.85).<bold>Conclusions: </bold>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).
- Subjects
ATRIAL fibrillation; CATASTROPHIC illness; LENGTH of stay in hospitals; INTENSIVE care units; LONGITUDINAL method; SEPSIS; DISEASE incidence; DISEASE complications
- Publication
American Journal of Respiratory & Critical Care Medicine, 2017, Vol 195, Issue 2, p205
- ISSN
1073-449X
- Publication type
journal article
- DOI
10.1164/rccm.201603-0618OC