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Published in: BMC Anesthesiology 1/2023

Open Access 01-12-2023 | Septicemia | Research

Atrial fibrillation is not an independent determinant of 28-day mortality among critically III sepsis patients

Authors: Weiping Wang, Yujiang Dong, Qian Zhang, Hongmei Gao

Published in: BMC Anesthesiology | Issue 1/2023

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Abstract

This study was conducted to investigate the relationship between atrial fibrillation and the clinical prognosis of patients with sepsis in intensive care unit. A total of 21,538 sepsis patients were enrolled in the study based on the Medical Information Mart for Intensive Care IV database, of whom 6,759 had AF. Propensity score matching was used to compare the clinical characteristics and outcomes of patients with and without AF. Besides, the inverse probability of treatment weighting, univariate and multivariate Cox regression analyzes were performed. Of the 21,538 patients, 31.4% had AF. The prevalence of AF increased in a step-by-step manner with growing age. Patients with AF were older than those without AF. After PSM, 11,180 patients remained, comprising 5,790 matched pairs in both groups. In IPTW, AF was not associated with 28-day mortality [hazard ratio (HR), 1.07; 95% confidence interval (CI), 0.99–1.15]. In Kaplan-Meier analysis, it was not observed difference of 28-day mortality between patients with and without AF. AF could be associated with increased ICU LOS, hospital LOS and need for mechanical ventilation; however, it does not remain an independent short-term predictor of 28-day mortality among patients with sepsis after PSM with IPTW and multivariate analysis.
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Literature
1.
go back to reference Walkey AJ, Lagu T, Lindenauer PK. Trends in sepsis and infection sources in the United States. A population-based study. Ann Am Thorac Soc. 2015;12:216–20.CrossRefPubMedPubMedCentral Walkey AJ, Lagu T, Lindenauer PK. Trends in sepsis and infection sources in the United States. A population-based study. Ann Am Thorac Soc. 2015;12:216–20.CrossRefPubMedPubMedCentral
2.
go back to reference Liu V, et al. Hospital deaths in patients with sepsis from 2 independent cohorts. JAMA. 2014;312:90–2.CrossRefPubMed Liu V, et al. Hospital deaths in patients with sepsis from 2 independent cohorts. JAMA. 2014;312:90–2.CrossRefPubMed
3.
go back to reference Machado FR, et al. The epidemiology of sepsis in brazilian intensive care units (the Sepsis PREvalence Assessment Database, SPREAD): an observational study. Lancet Infect Dis. 2017;17:1180–9.CrossRefPubMed Machado FR, et al. The epidemiology of sepsis in brazilian intensive care units (the Sepsis PREvalence Assessment Database, SPREAD): an observational study. Lancet Infect Dis. 2017;17:1180–9.CrossRefPubMed
4.
go back to reference Lagu T, et al. Hospitalizations, costs, and outcomes of severe sepsis in the United States 2003 to 2007. Crit Care Med. 2012;40:754–61.CrossRefPubMed Lagu T, et al. Hospitalizations, costs, and outcomes of severe sepsis in the United States 2003 to 2007. Crit Care Med. 2012;40:754–61.CrossRefPubMed
5.
go back to reference Schwartz A, Brotfain E, Koyfman L, Klein M. Cardiac arrhythmias in a septic ICU Population: a review. J Crit care Med (Universitatea de Med si Farm din Targu-Mures). 2015;1:140–6. Schwartz A, Brotfain E, Koyfman L, Klein M. Cardiac arrhythmias in a septic ICU Population: a review. J Crit care Med (Universitatea de Med si Farm din Targu-Mures). 2015;1:140–6.
6.
go back to reference Hindricks G et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021;42(5):373–498. Hindricks G et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021;42(5):373–498.
8.
go back to reference McIntyre WF, et al. Atrial fibrillation detected initially during acute medical illness: a systematic review. Eur Heart J Acute Cardiovasc care. 2019;8:130–41.CrossRefPubMed McIntyre WF, et al. Atrial fibrillation detected initially during acute medical illness: a systematic review. Eur Heart J Acute Cardiovasc care. 2019;8:130–41.CrossRefPubMed
11.
go back to reference Walkey AJ, et al. Atrial fibrillation among Medicare beneficiaries hospitalized with sepsis: incidence and risk factors. Am Heart J. 2013;165:949–955e943.CrossRefPubMedPubMedCentral Walkey AJ, et al. Atrial fibrillation among Medicare beneficiaries hospitalized with sepsis: incidence and risk factors. Am Heart J. 2013;165:949–955e943.CrossRefPubMedPubMedCentral
12.
go back to reference Bashar SK, Ding EY, Walkey AJ, McManus DD, Chon KH. Atrial Fibrillation Prediction from Critically Ill Sepsis Patients. Biosensors 11(2021). Bashar SK, Ding EY, Walkey AJ, McManus DD, Chon KH. Atrial Fibrillation Prediction from Critically Ill Sepsis Patients. Biosensors 11(2021).
13.
14.
go back to reference Christian SA, et al. Clinical characteristics and outcomes of septic patients with new-onset atrial fibrillation. J Crit Care. 2008;23:532–6.CrossRefPubMed Christian SA, et al. Clinical characteristics and outcomes of septic patients with new-onset atrial fibrillation. J Crit Care. 2008;23:532–6.CrossRefPubMed
15.
go back to reference Ferrera C, et al. Usefulness of New-Onset Atrial Fibrillation, as a strong predictor of heart failure and death in patients with native left-sided infective endocarditis. Am J Cardiol. 2016;117:427–33.CrossRefPubMed Ferrera C, et al. Usefulness of New-Onset Atrial Fibrillation, as a strong predictor of heart failure and death in patients with native left-sided infective endocarditis. Am J Cardiol. 2016;117:427–33.CrossRefPubMed
16.
go back to reference Gandhi S, Litt D, Narula N. New-onset atrial fibrillation in sepsis is associated with increased morbidity and mortality. Neth Heart Journal: Monthly J Neth Soc Cardiol Neth Heart Foundation. 2015;23:82–8.CrossRef Gandhi S, Litt D, Narula N. New-onset atrial fibrillation in sepsis is associated with increased morbidity and mortality. Neth Heart Journal: Monthly J Neth Soc Cardiol Neth Heart Foundation. 2015;23:82–8.CrossRef
17.
go back to reference Liu WC, et al. Prognostic impact of restored sinus rhythm in patients with sepsis and new-onset atrial fibrillation. Crit Care (London England). 2016;20:373.CrossRef Liu WC, et al. Prognostic impact of restored sinus rhythm in patients with sepsis and new-onset atrial fibrillation. Crit Care (London England). 2016;20:373.CrossRef
19.
go back to reference Walkey AJ, Wiener RS, Ghobrial JM, Curtis LH, Benjamin EJ. Incident stroke and mortality associated with new-onset atrial fibrillation in patients hospitalized with severe sepsis. JAMA. 2011;306:2248–54.CrossRefPubMedPubMedCentral Walkey AJ, Wiener RS, Ghobrial JM, Curtis LH, Benjamin EJ. Incident stroke and mortality associated with new-onset atrial fibrillation in patients hospitalized with severe sepsis. JAMA. 2011;306:2248–54.CrossRefPubMedPubMedCentral
20.
go back to reference Klein Klouwenberg PM, et al. Incidence, predictors, and outcomes of New-Onset Atrial Fibrillation in critically ill patients with Sepsis. A cohort study. Am J Respir Crit Care Med. 2017;195:205–11.CrossRefPubMed Klein Klouwenberg PM, et al. Incidence, predictors, and outcomes of New-Onset Atrial Fibrillation in critically ill patients with Sepsis. A cohort study. Am J Respir Crit Care Med. 2017;195:205–11.CrossRefPubMed
21.
22.
go back to reference Harada M, Van Wagoner DR, Nattel S. Role of inflammation in atrial fibrillation pathophysiology and management. Circulation Journal: Official Journal of the Japanese Circulation Society. 2015;79:495–502.CrossRefPubMed Harada M, Van Wagoner DR, Nattel S. Role of inflammation in atrial fibrillation pathophysiology and management. Circulation Journal: Official Journal of the Japanese Circulation Society. 2015;79:495–502.CrossRefPubMed
23.
go back to reference Abbasi MA, Balasi J, Gharab SG, Abdolhay MJ, Gandomi A. Prevalence and risk factors of New-Onset Atrial Fibrillation and its role in the prognosis of critically ill patients. (2020). Abbasi MA, Balasi J, Gharab SG, Abdolhay MJ, Gandomi A. Prevalence and risk factors of New-Onset Atrial Fibrillation and its role in the prognosis of critically ill patients. (2020).
25.
go back to reference Wu CS, et al. Atrial fibrillation is not an independent determinant of Mortality among critically ill acute ischemic stroke patients: a propensity score-matched analysis from the MIMIC-IV Database. Front Neurol. 2021;12:730244.CrossRefPubMed Wu CS, et al. Atrial fibrillation is not an independent determinant of Mortality among critically ill acute ischemic stroke patients: a propensity score-matched analysis from the MIMIC-IV Database. Front Neurol. 2021;12:730244.CrossRefPubMed
26.
go back to reference Goldberger AL, et al. PhysioBank, PhysioToolkit, and PhysioNet: components of a new research resource for complex physiologic signals. Circulation. 2000;101:E215–220.CrossRefPubMed Goldberger AL, et al. PhysioBank, PhysioToolkit, and PhysioNet: components of a new research resource for complex physiologic signals. Circulation. 2000;101:E215–220.CrossRefPubMed
27.
go back to reference Johnson A, Bulgarelli L, Pollard T, Horng S, Celi LA, Mark R. MIMIC-IV (version 1.0). PhysioNet. (2021). Johnson A, Bulgarelli L, Pollard T, Horng S, Celi LA, Mark R. MIMIC-IV (version 1.0). PhysioNet. (2021).
28.
go back to reference World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310:2191–4.CrossRef World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310:2191–4.CrossRef
30.
go back to reference White IR, Royston P, Wood AM. Multiple imputation using chained equations: issues and guidance for practice. Stat Med. 2011;30:377–99.CrossRefPubMed White IR, Royston P, Wood AM. Multiple imputation using chained equations: issues and guidance for practice. Stat Med. 2011;30:377–99.CrossRefPubMed
31.
32.
go back to reference Austin PC. An introduction to Propensity score methods for reducing the Effects of confounding in Observational Studies. Multivar Behav Res. 2011;46:399–424.CrossRef Austin PC. An introduction to Propensity score methods for reducing the Effects of confounding in Observational Studies. Multivar Behav Res. 2011;46:399–424.CrossRef
33.
go back to reference Austin PC, Stuart EA. Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Stat Med. 2015;34:3661–79.CrossRefPubMedPubMedCentral Austin PC, Stuart EA. Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Stat Med. 2015;34:3661–79.CrossRefPubMedPubMedCentral
34.
go back to reference Wells GL, Morris PE. Incidence and prognosis of Atrial Fibrillation in patients with Sepsis. Cardiol Res. 2011;2:293–7.PubMedPubMedCentral Wells GL, Morris PE. Incidence and prognosis of Atrial Fibrillation in patients with Sepsis. Cardiol Res. 2011;2:293–7.PubMedPubMedCentral
35.
go back to reference Desai R, et al. Trends and Outcomes in Sepsis Hospitalizations with and without Atrial Fibrillation: a Nationwide Inpatient Analysis. Crit Care Med. 2019;47:e630–8.CrossRefPubMed Desai R, et al. Trends and Outcomes in Sepsis Hospitalizations with and without Atrial Fibrillation: a Nationwide Inpatient Analysis. Crit Care Med. 2019;47:e630–8.CrossRefPubMed
36.
go back to reference Walkey AJ, Hammill BG, Curtis LH, Benjamin EJ. Long-term outcomes following development of new-onset atrial fibrillation during sepsis. Chest. 2014;146:1187–95.CrossRefPubMedPubMedCentral Walkey AJ, Hammill BG, Curtis LH, Benjamin EJ. Long-term outcomes following development of new-onset atrial fibrillation during sepsis. Chest. 2014;146:1187–95.CrossRefPubMedPubMedCentral
37.
go back to reference Barnato A, Alexander S, Linde-Zwirble W, Angus D. Racial variation in the incidence, Care, and outcomes of severe Sepsis: analysis of Population, patient, and Hospital characteristics. Am J Respir Crit Care Med. 2008;177:279–84.CrossRefPubMed Barnato A, Alexander S, Linde-Zwirble W, Angus D. Racial variation in the incidence, Care, and outcomes of severe Sepsis: analysis of Population, patient, and Hospital characteristics. Am J Respir Crit Care Med. 2008;177:279–84.CrossRefPubMed
38.
go back to reference Seguin P, Signouret T, Laviolle B, Branger B, Mallédant Y. Incidence and risk factors of atrial fibrillation in a surgical intensive care unit. Crit Care Med. 2004;32:722–6.CrossRefPubMed Seguin P, Signouret T, Laviolle B, Branger B, Mallédant Y. Incidence and risk factors of atrial fibrillation in a surgical intensive care unit. Crit Care Med. 2004;32:722–6.CrossRefPubMed
39.
go back to reference Wetterslev M, et al. Atrial fibrillation (AFIB) in the ICU: incidence, risk factors, and outcomes: the international AFIB-ICU cohort study. Crit Care Med. 2023;51:1124–37.CrossRefPubMed Wetterslev M, et al. Atrial fibrillation (AFIB) in the ICU: incidence, risk factors, and outcomes: the international AFIB-ICU cohort study. Crit Care Med. 2023;51:1124–37.CrossRefPubMed
40.
go back to reference Salman S, Bajwa A, Gajic O, Afessa B. Paroxysmal atrial fibrillation in critically ill patients with sepsis. J Intensive Care Med. 2008;23:178–83.CrossRefPubMed Salman S, Bajwa A, Gajic O, Afessa B. Paroxysmal atrial fibrillation in critically ill patients with sepsis. J Intensive Care Med. 2008;23:178–83.CrossRefPubMed
41.
go back to reference Poncet A, Perneger TV, Merlani P, Capuzzo M, Combescure C. Determinants of the calibration of SAPS II and SAPS 3 mortality scores in intensive care: a european multicenter study. Crit Care (London England). 2017;21:85.CrossRef Poncet A, Perneger TV, Merlani P, Capuzzo M, Combescure C. Determinants of the calibration of SAPS II and SAPS 3 mortality scores in intensive care: a european multicenter study. Crit Care (London England). 2017;21:85.CrossRef
42.
go back to reference D’Agostino RB. Jr. Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med. 1998;17:2265–81.CrossRefPubMed D’Agostino RB. Jr. Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med. 1998;17:2265–81.CrossRefPubMed
Metadata
Title
Atrial fibrillation is not an independent determinant of 28-day mortality among critically III sepsis patients
Authors
Weiping Wang
Yujiang Dong
Qian Zhang
Hongmei Gao
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2023
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-023-02281-z

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