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Medline ® Abstract for Reference 98

of 'Sepsis syndromes in adults: Epidemiology, definitions, clinical presentation, diagnosis, and prognosis'

Incident stroke and mortality associated with new-onset atrial fibrillation in patients hospitalized with severe sepsis.
Walkey AJ, Wiener RS, Ghobrial JM, Curtis LH, Benjamin EJ
JAMA. 2011 Nov;306(20):2248-54. Epub 2011 Nov 13.
CONTEXT: New-onset atrial fibrillation (AF) has been reported in 6% to 20% of patients with severe sepsis. Chronic AF is a known risk factor for stroke and death, but the clinical significance of new-onset AF in the setting of severe sepsis is uncertain.
OBJECTIVE: To determine the in-hospital stroke and in-hospital mortality risks associated with new-onset AF in patients with severe sepsis.
DESIGN AND SETTING: Retrospective population-based cohort of California State Inpatient Database administrative claims data from nonfederal acute care hospitals for January 1 through December 31, 2007.
PATIENTS: Data were available for 3,144,787 hospitalized adults. Severe sepsis (n = 49,082 [1.56%]) was defined by validated International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 995.92. New-onset AF was defined as AF that occurred during the hospital stay,after excluding AF cases present at admission.
MAIN OUTCOME MEASURES: A priori outcome measures were in-hospital ischemic stroke (ICD-9-CM codes 433, 434, or 436) and mortality.
RESULTS: Patients with severe sepsis were a mean age of 69 (SD, 16) years and 48% were women. New-onset AF occurred in 5.9% of patients with severe sepsis vs 0.65% of patients without severe sepsis (multivariable-adjusted odds ratio [OR], 6.82; 95% CI, 6.54-7.11; P<.001). Severe sepsis was present in 14% of all new-onset AF in hospitalized adults. Compared with severe sepsis patients without new-onset AF, patients with new-onset AF during severe sepsis had greater risks of in-hospital stroke (75/2896 [2.6%]vs 306/46,186 [0.6%]strokes; adjusted OR, 2.70; 95% CI, 2.05-3.57; P<.001) and in-hospital mortality (1629 [56%]vs 18,027 [39%]deaths; adjusted relative risk, 1.07; 95% CI, 1.04-1.11; P<.001). Findings were robust across 2 definitions of severe sepsis, multiple methods of addressing confounding, and multiple sensitivity analyses.
CONCLUSION: Among patients with severe sepsis, patients with new-onset AF were at increased risk of in-hospital stroke and death compared with patients with no AF and patients with preexisting AF.
Pulmonary Center, Division of Pulmonary and Critical Care Medicine, Boston University School of Medicine, R-304, Boston, MA 02118, USA. alwalkey@bu.edu