Incidence and Prognosis of Sustained Arrhythmias in Critically Ill Patients

Annane, Djillali; Sébille, Véronique; Duboc, Denis; Heuzey, Jean‐Yves Le; Sadoul, Nicolas; Bouvier, Erik; Bellissant, Éric

doi:10.1164/rccm.200701-031oc

Cited by 181 publications

(147 citation statements)

References 25 publications

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“…In general, patients with severe sepsis were more likely to be older in age, to have CHF, PVD, chronic obstructive pulmonary disease (COPD), DM and renal disease. Ischemic heart disease* 2,161,685 [7] 174,130 [10] CHF* 4,048,500 [14] 427,525 [24] PVD* 1,778,205 [6] 166,975 [10] Cerebrovascular disease* 1,952,330 [7] 144,150 [8] Chronic pulmonary disease* 6,493,627 [22] 495,285 [28] DM* 5,967,546 [21] 499,900 [28] DM with complications* 1,143,775 [4] 127,005 [7] Renal disease* 3,668,071 [13] 465,995 [27] Valvular heart disease* 1,717,610 [6] 131,640 [7] *Comparison between two groups done with Chi-square test. All P values significant at <0.05.…”

Section: Resultsmentioning

confidence: 99%

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Severe sepsis and cardiac arrhythmias

Shahreyar¹,

Fahhoum²,

Akinseye³

et al. 2018

Ann. Transl. Med.

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Background: Although sepsis is a known risk factor for cardiac arrhythmias, data on incidence and outcomes of atrial and ventricular arrhythmias in severe sepsis is limited. The purpose of this study is to examine the association of severe sepsis with cardiac arrhythmias and their impact on outcome in this patient population. Methods:We used hospital discharge data from the Nationwide Inpatient Sample (NIS) during the year 2012. All patients 18 years or older were included in the study. The International Classification of Diseases-Clinical Modification, 9th revision (ICD-9-CM) code was used to identify patients with discharge diagnosis of severe sepsis, atrial fibrillation (A Fib), atrial flutter (AFL), ventricular fibrillation (VF) arrest and non-ventricular fibrillation (non-VF) arrest. In order to study the association of arrhythmias with severe sepsis, two groups were defined: group a-with severe sepsis was compared to group b-without severe sepsis. Univariate and multivariate logistic regression methods were used to adjust for potential confounding factors and variables associated with cardiac arrhythmias were determined.Results: A total of 30,712,524 NIS hospital discharges (weighted for national estimate) were included in our study, of which 1,756,965 (5.7%) had severe sepsis. On multivariate analysis, after adjusting for potential confounders, severe sepsis was associated with higher risk of A Fib (OR, 1.23; 95% CI, 1.21-1.24), AFL (OR, 1.34; 95% CI, 1.30-1.40), VF arrest (OR, 2.58; 95% CI, 2.38-2.79) (OR, 3.31; 95% CI, 3.07-3.57) and non-VF arrest (OR, 4.91; 95% CI,). In the severe sepsis group, cardiac arrhythmia was associated with higher in-hospital mortality (OR, 1.41; 95% CI, 1.37-1.45), length of stay (LOS) >75% quartile (OR, 1.50; 95% CI, 1.46-1.53) and total hospital charges >75% quartile (OR, 1.37; 95% CI, 1.34-1.41). Advanced age, male sex, ischemic heart disease, diabetes mellitus (DM), congestive heart failure (CHF), valvular heart disease, respiratory failure, mechanical ventilation and use of vasopressors were independently associated with cardiac arrhythmias. Conclusions:Patients with severe sepsis are at high risk of atrial and life threatening ventricular arrhythmias. Despite adjustment for potential confounding factors, patients hospitalized with severe sepsis carry a significantly higher risk for cardiac arrest and increased mortality.

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Section: Resultsmentioning

confidence: 99%

“…Compared to patients with preexisting A Fib, new onset A Fib has been associated with higher mortality rates (4). Furthermore, both atrial and ventricular arrhythmias have been associated with a higher incidence of neurologic compromise (22) and prolonged need for vasopressors (23).…”

Section: Discussionmentioning

confidence: 99%

Severe sepsis and cardiac arrhythmias

Shahreyar¹,

Fahhoum²,

Akinseye³

et al. 2018

Ann. Transl. Med.

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“…First, the incidence of severe sepsis-associated, new-onset AF in our study (5.9%) was on the lower end of previously reported rates (6-20%). [2][3][4][5] AF incidence in our study may be lower because claims data are less sensitive for detecting new-onset AF as compared with the chart abstraction or prospective identification used in prior studies. Additionally, new-onset AF that occurred upon hospital admission in the setting of severe sepsis may be classified as "pre-existing AF" by the "present on admission" coding strategy used in our study, which might falsely lower the observed incidence of AF or bias outcome analyses.…”

Section: Discussionmentioning

confidence: 99%

“…Atrial fibrillation (AF) is the most common arrhythmia to affect the critically ill. 1,2 Previous studies have demonstrated that 6-20% of patients with severe sepsis develop new-onset AF, suggesting that severe sepsis may be a predisposing factor for new-onset AF. [2][3][4][5] Whereas chronic AF is a major contributor to long-term disability and mortality, 6 the relation of newonset AF in severe sepsis to prognosis is unknown.…”

Section: Introductionmentioning

confidence: 99%

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Incident Stroke and Mortality Associated With New-Onset Atrial Fibrillation in Patients Hospitalized With Severe Sepsis

Walkey¹,

Wiener²,

Ghobrial³

et al. 2012

Survey of Anesthesiology

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Context-New-onset fibrillation (AF) has been reported in 6-20% of patients with severe sepsis. Whereas chronic AF is a known risk factor for stroke and death, the clinical significance of newonset 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. Conclusion-Among patients with severe sepsis, patients with new-onset AF were at increased risk for in-hospital stroke and death compared with patients with no AF and patients with preexisting AF. Design-Retrospective

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Incident Stroke and Mortality Associated With New-Onset Atrial Fibrillation in Patients Hospitalized With Severe Sepsis

Walkey¹,

Wiener²,

Ghobrial³

et al. 2011

JAMA

395

392

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Context New-onset fibrillation (AF) has been reported in 6–20% of patients with severe sepsis. Whereas chronic AF is a known risk factor for stroke and death, 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 Retrospective population-based cohort of California State Inpatient Database administrative claims data from 1/1/2007 through 12/31/2007. Setting Non-Federal acute care hospitals. Patients Data was available from 3,144,787 hospitalized adults. Severe sepsis [N=49,082 (1.56%)] was defined by validated 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 of 433, 434, or 436) and mortality. Results Patients with severe sepsis were 69±16 years old and 48% were women. New-onset atrial fibrillation occurred in 5.9% of patients with severe sepsis versus 0.6% of patients without severe sepsis [multivariable-adjusted odds ratio (OR), 6.82; 95% confidence interval (CI), 6.54–7.11; P<0.001]. 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. 306/46186 (0.6%) strokes, adjusted OR 2.70; 95% CI, 2.05–3.57; P <0.0001) and in-hospital mortality (1629 (56%) vs. 18027 (39%) deaths, adjusted relative risk, 1.07; 95% CI, 1.04–1.11; P <0.0001). Findings were robust across two 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 for in-hospital stroke and death compared with patients with no AF and patients with pre-existing AF.

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Incidence and Prognosis of Sustained Arrhythmias in Critically Ill Patients

Abstract: Sustained arrhythmias are observed in 12% of patients admitted to general ICUs. Ventricular arrhythmias increase the risk of death.

Cited by 181 publications

References 25 publications

Severe sepsis and cardiac arrhythmias

Severe sepsis and cardiac arrhythmias

Incident Stroke and Mortality Associated With New-Onset Atrial Fibrillation in Patients Hospitalized With Severe Sepsis

Incident Stroke and Mortality Associated With New-Onset Atrial Fibrillation in Patients Hospitalized With Severe Sepsis

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