Peter M. C. Klein Klouwenberg , Jos F. Frencken , Sanne Kuipers , David S. Y. Ong , Linda M. Peelen , Lonneke A. van Vught , Marcus J. Schultz , Tom van der Poll , Marc J. Bonten , and Olaf L. Cremer ; on behalf of the MARS Consortium Am. J. Resp. Crit. Care Med. Jan 15, 2017, vol. 195, no. 2: 205-211
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; P = 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.