New-Onset Atrial Fibrillation in Bacteremia Is Not Associated with C-Reactive Protein, but Is an Indicator of Increased Mortality during Hospitalization

Kindem, Ingvild Andrea; Reindal, Eva Kristine; Wester, Astrid Louise; Blaasaas, Karl Gerhard; Atar, Dan

doi:10.1159/000121600

Cited by 11 publications

(10 citation statements)

References 81 publications

(55 reference statements)

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“…These results are consistent with, and build upon, several previous reports that development of AF in the ICU is associated with increased mortality, which are summarized in Supplemental Table 4 (1, 3-5, 7, 9, 11-13). Our study provides important new information compared to prior studies because the large cohort of patients with AF allowed us to determine that the association of AF with mortality in critical illness is not simply due to AF being a marker of increased disease severity.…”

Section: Discussionsupporting

confidence: 92%

“…As most previous studies of AF in the critically-ill have focused specifically on patients with sepsis (7, 9, 11, 16), we tested whether the impact of AF differed in the presence or absence of sepsis. As anticipated, patients with sepsis were more likely to develop AF in the ICU than those without sepsis.…”

Section: Discussionmentioning

confidence: 99%

“…Several previous reports have suggested that development of new-onset AF in the intensive care unit portends increased mortality (1, 3-7, 9, 11-13, 15-17), particularly in patients with sepsis. Despite these reports, it remains unclear whether the association between mortality and AF in critical illness is due to AF itself or due to AF simply being a marker of greater severity of illness.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Atrial Fibrillation Is an Independent Predictor of Mortality in Critically Ill Patients*

Shaver

Chen

Janz

et al. 2015

Critical Care Medicine

129

127

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Objective Atrial fibrillation (AF) has been associated with increased mortality in critically-ill patients. We sought to determine whether AF in the intensive care unit (ICU) is an independent risk factor for death. A secondary objective was to determine if patients with new-onset AF have different risk factors or outcomes compared to patients with a previous history of AF. Design Prospective observational cohort study. Setting Medical and general surgical ICUs in a tertiary academic medical center. Patients 1,770 critically-ill patients requiring at least 2 days in the ICU. Interventions None. Measurements Demographics, medical history, development of AF, fluid balance, echocardiographic findings, medication administration, and hospital mortality were collected during the first four days of ICU admission. Main Results AF occurred in 236 (13%) patients (Any AF). Of these, 123 patients (7%) had no prior AF (New-onset AF) while the remaining 113 (6%) had Recurrent AF. Any AF was associated with male gender, Caucasian race, increased age, cardiac disease, organ failures, and disease severity. Patients with Any AF had increased mortality compared to those without AF (31% vs. 17%, p <0.001) and Any AF was independently associated with death (OR 1.62, 95% CI 1.14-2.29, p=0.007) in multivariable analysis controlling for severity of illness and other confounders. The association of AF with death was magnified in patients without sepsis (OR 2.92, 95% CI 1.52-5.60, p=0.001). Treatment for AF had no effect on hospital mortality. New-onset AF and Recurrent AF were each associated with increased mortality. New-onset AF, but not Recurrent AF, was associated with increased diastolic dysfunction and vasopressor use and a greater cumulative positive fluid balance. Conclusions AF in critical illness, whether new-onset or recurrent, is independently associated with increased hospital mortality, especially in patients without sepsis.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Atrial Fibrillation Is an Independent Predictor of Mortality in Critically Ill Patients*

Shaver

Chen

Janz

et al. 2015

Critical Care Medicine

129

127

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“…C-reactive protein (CRP) values from blood samples drawn on the day of admission were categorized at 80 mg/L, which is applicable for predicting sepsis in patients with SIRS [17], and 200 mg/L, which is the suggested level for differentiating infection from other causes of shock [18]. We included new-onset atrial fibrillation as a marker of severe infection, as described previously [19]. …”

Section: Methodsmentioning

confidence: 99%

Age-related differences in symptoms, diagnosis and prognosis of bacteremia

et al. 2013

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BackgroundElderly patients are at particular risk for bacteremia and sepsis. Atypical presentation may complicate the diagnosis. We studied patients with bacteremia, in order to assess possible age-related effects on the clinical presentation and course of severe infections.MethodsWe reviewed the records of 680 patients hospitalized between 1994 and 2004. All patients were diagnosed with bacteremia, 450 caused by Escherichia coli and 230 by Streptococcus pneumoniae. Descriptive analyses were performed for three age groups (< 65 years, 65–84 years, ≥ 85 years). In multivariate analyses age was dichotomized (< 65, ≥ 65 years). Symptoms were categorized into atypical or typical. Prognostic sensitivity of CRP and SIRS in identifying early organ failure was studied at different cut-off values. Outcome variables were organ failure within one day after admission and in-hospital mortality.ResultsThe higher age-groups more often presented atypical symptoms (p <0.001), decline in general health (p=0.029), and higher in-hospital mortality (p<0.001). The prognostic sensitivity of CRP did not differ between age groups, but in those ≥ 85 years the prognostic sensitivity of two SIRS criteria was lower than that of three criteria. Classical symptoms were protective for early organ failure (OR 0.67, 95% CI 0.45-0.99), and risk factors included; age ≥ 65 years (OR 1.65, 95% CI 1.09-2.49), comorbid illnesses (OR 1.19, 95% CI 1.02-1.40 per diagnosis), decline in general health (OR 2.28, 95% CI 1.58-3.27), tachycardia (OR 1.50, 95% CI 1.02-2.20), tachypnea (OR 3.86, 95% CI 2.64-5.66), and leukopenia (OR 4.16, 95% CI 1.59-10.91). Fever was protective for in-hospital mortality (OR 0.46, 95% CI 0.24-0.89), and risk factors included; age ≥ 65 years (OR 15.02, 95% CI 3.68-61.29), ≥ 1 comorbid illness (OR 2.61, 95% CI 1.11-6.14), bacteremia caused by S. pneumoniae (OR 2.79, 95% CI 1.43-5.46), leukopenia (OR 4.62, 95% CI 1.88-11.37), and number of early failing organs (OR 3.06, 95% CI 2.20-4.27 per failing organ).ConclusionsElderly patients with bacteremia more often present with atypical symptoms and reduced general health. The SIRS-criteria have poorer sensitivity for identifying organ failure in these patients. Advanced age, comorbidity, decline in general health, pneumococcal infection, and absence of classical symptoms are markers of a poor prognosis.

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“…Although an association between inflammation and AF is undoubtedly present, it is still unclear whether inflammation is a cause or merely a consequence of AF [9]. In the past few years, several clinical trials have examined clinical inflammatory biomarkers that predict the success of CV and the maintenance of sinus rhythm [10,11,12,13,14,15,16].…”

Section: Introductionmentioning

confidence: 99%

The Effect of Sinus Rhythm Restoration on High-Sensitivity C-Reactive Protein Levels and Their Association with Long-Term Atrial Fibrillation Recurrence after Electrical Cardioversion

Çelebi¹,

Celebi²,

Canbay³

et al. 2011

Cardiology

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Objective: Recent studies have shown that high-sensitivity C-reactive protein (hs-CRP) measured before cardioversion (CV) plays a significant role in predicting atrial fibrillation (AF) relapse. The time course of changes in hs-CRP after successful electrical CV remains controversial. The aim of the present study was to assess the prognostic value of pre- and post-CV hs-CRP levels in predicting the long-term risk of AF. Additionally, we evaluated changes in hs-CRP levels over time following a successful CV. Methods: This prospective study comprised 216 patients with persistent AF who underwent CV (mean age 51.94 ± 8.07 years; 55.6% men). hs-CRP levels were examined in all patients, and blood samples were taken prior to and 1, 2, 7 and 30 days after CV. AF relapse was determined by 24-hour ambulatory electrocardiogram (ECG) monitoring and 12-lead standard ECG during 12 months of follow-up. We further divided the study population into two groups according to their rhythm at the end of the follow-up period (group A: patients with AF at the end of follow-up; group B: patients with sinus rhythm at the end of the follow-up period). Results: The AF recurrence rate was 42.2% throughout the 12-month follow-up period. The basal hs-CRP levels were higher in patients with an AF relapse than in those without (1.68 ± 0.57 vs. 1.12 ± 0.53 mg/dl; p < 0.01). The hs-CRP levels were significantly decreased at 30 days in group B, whereas there was no significant decrease in group A (from 1.12 ± 0.53 to 0.69 ± 0.33 mg/dl, p < 0.01, and from 1.68 ± 0.57 to 1.69 ± 0.76 mg/dl, p > 0.05, respectively). By multivariate Cox analysis, the independent predictors of AF relapse time points were the basal and day-2 hs-CRP levels. Receiver operating characteristic curve analysis showed that the cutoff value of hs-CRP on the 2nd day for predicting AF relapse was 1.85 mg/dl, with a sensitivity of 62%, a specificity of 82%, a positive predictive value of 85.7% and a negative predictive value of 81.6%. Conclusion: The hs-CRP levels both prior to and after CV predict the long-term risk of AF relapse. In the present study, hs-CRP levels were significantly decreased in patients who remained in sinus rhythm at the end of the study. In contrast, hs-CRP levels remained high throughout the follow-up in patients with an AF relapse.

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New-Onset Atrial Fibrillation in Bacteremia Is Not Associated with C-Reactive Protein, but Is an Indicator of Increased Mortality during Hospitalization

Cited by 11 publications

References 81 publications

Atrial Fibrillation Is an Independent Predictor of Mortality in Critically Ill Patients*

Atrial Fibrillation Is an Independent Predictor of Mortality in Critically Ill Patients*

Age-related differences in symptoms, diagnosis and prognosis of bacteremia

The Effect of Sinus Rhythm Restoration on High-Sensitivity C-Reactive Protein Levels and Their Association with Long-Term Atrial Fibrillation Recurrence after Electrical Cardioversion

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