Early Coagulation Disorder Is Associated With an Increased Risk of Atrial Fibrillation in Septic Patients

Abstract

Background: Atrial fibrillation (AF) and coagulation disorder, two common complications of sepsis, are associated with the mortality. However, the relationship between early coagulation disorder and AF in sepsis remains elusive. This study aimed to evaluate the interaction between AF and early coagulation disorder on mortality.Methods: In this retrospective study, all data were extracted from the Medical Information Mart for Intensive Care III (MIMIC-III) database. Septic patients with coagulation tests during the first 24 h after admission to intensive care units (ICUs) meeting study criteria were included in the analysis. Early coagulation disorder is defined by abnormalities in platelet count (PLT), international normalized ratio (INR) and activated partial thromboplastin time (APTT) within the first 24 h after admission, whose score was defined with reference to sepsis-induced coagulopathy (SIC) and coagulopathy. Patients meeting study criteria were divided into AF and non-AF groups.Results: In total, 7,528 septic patients were enrolled, including 1,243 (16.51%) with AF and 5,112 (67.91%) with early coagulation disorder. Compared with patients in the non-AF group, patients in the AF group had higher levels of INR and APTT (P < 0.001). Multivariable logistic regression analyses showed that stroke, early coagulation disorder, age, gender, congestive heart failure (CHF), chronic pulmonary disease, renal failure, and chronic liver disease were independent risk factors for AF. In addition, AF was related to in-hospital mortality and 90-day mortality. In the subgroup analysis stratified by the scores of early coagulation disorder, AF was associated with an increased risk of 90-day mortality when the scores of early coagulation disorder were 1 or 2 and 3 or 4.Conclusion: In sepsis, coagulation disorder within the first 24 h after admission to the ICUs is an independent risk factor for AF. The effect of AF on 90-day mortality varies with the severity of early coagulation disorder.

NT-proBNP Levels and Collateral Circulation Status in Patients with Acute Ischemic Stroke

“…Non-AF ischemic stroke was also observed to be related to hazard elements such as gender (male), high BMI, and smoking, which is consistent with preceding findings [31]. In addition, TnI, D-dimer, aPTT, and INR degrees have been higher within the AF organization, that is, regular with preceding studies, as coagulation problems are associated with an excessive hazard of AF [32,33].…”

A retrospective cohort study on the association between early coagulation disorder and short-term all-cause mortality of critically ill patients with congestive heart failure

“…The present study was a single-center, retrospective cohort study to assess the association between coagulation disorder score and the risk of adverse outcomes in critically ill patients with CHF. The coagulation disorder score was defined by platelet count, INR, and APTT with reference to the sepsisinduced coagulopathy (SIC) score and coagulopathy according to previous studies (Table 2) (18). The optimal cutoff was determined using X-tile software (Yale University, New Haven, CT) (21,22).…”

“…On this basis, Long et al reported a composite coagulation disorder score with reference to SIC score and coagulopathy to evaluate early coagulation dysfunction, which combines the platelet count, INR and activated partial thromboplastin time (APTT). This score could effectively predict the risk of atrial fibrillation in patients with sepsis, which is associated with the 90-day mortality of patients (18). The major pathways that contribute to DIC include platelet and inflammatory cell activation and endothelial damage, which are the major hallmarks of heart failure (19).…”

Development and validation of a predictive model for new-onset atrial fibrillation in sepsis based on clinical risk factors

“…Sepsis-associated coagulopathy consists of a prolonged INR and a reduced platelet count, which was related to 28-day mortality in septic patients and was one way to assess disease severity ( 43 , 44 ). In a retrospective study of sepsis, coagulopathy within 24 h of admission was an independent risk factor for AF, with an INR of 1.5 (95%CI, 1.2–2.2) in the AF group ( 45 ). The INR was 1.46 (95%CI, 1.20–3.26) in this study, consistent with the above findings.…”