In-hospital Outcomes of Patients with Septic Shock and Underlying Chronic Atrial Fibrillation: A Propensity Matched Analysis from A National Dataset

Abstract

Introduction

Atrial fibrillation (AF) is one of the most common arrhythmias among hospitalized patients. Among patients admitted with septic shock (SS), the new occurrence of atrial fibrillation has been associated with an increase in intensive care unit (ICU) length of stay and in-hospital mortality. This is partially related to further reduction in cardiac output and thus worsening organ perfusion due to atrial fibrillation. However, there is a paucity of research on the outcomes of patients who have underlying chronic AF (UCAF) and then develop SS. This study aimed to identify the clinical characteristics and outcomes of patients with UCAF admitted with SS compared to patients with SS without UCAF.

Methods

This study was a retrospective analysis of the 2016 and 2017 Nationwide Readmission Database. ICD-10 codes were used to identify patients with SS, and these patients were stratified into those with and without UCAF. Propensity matching analyses were performed to compare clinical outcomes and in-hospital mortality between the two groups.

Results

A total of 353,422 patients with hospitalization for SS were identified, 5.8% (n = 20,772) of whom had UCAF. After 2:1 propensity matching, 20,719 patients were identified as having SS with UCAF, and 41,438 patients were identified as having SS without UCAF. Patients with SS and UCAF had a higher incidence of ischemic stroke [2.5% versus 2.2%, p = 0.012], length of stay [11.5 days versus 10.9 days, p < 0.001], mean total charges [$154,094 versus $144,037, p < 0.001] compared to those with SS without UCAF. In-hospital mortality was high in both groups, but was slightly higher among those with SS and UCAF than those with SS and no UCAF [34.4% versus 34.1%, p = 0.049].

Conclusions

This study identified UCAF as an adverse prognosticator for clinical outcomes. Patients with SS and UCAF need to be identified as a higher risk category of SS who will require more intensive management.

Keywords

septic shock atrial fibrillation

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References

Artucio

Pereira

. Cardiac arrhythmias in critically ill patients: Epidemiologic study. Crit Care Med. 1990;18(12):1383-1388.

Annane

Sébille

Duboc

, et al. Incidence and prognosis of sustained arrhythmias in critically ill patients. Am J Respir Crit Care Med. 2008;178(1):20-25.

Lippi

Sanchis-Gomar

Cervellin

. Global epidemiology of atrial fibrillation: An increasing epidemic and public health challenge. Int J Stroke. 2021;16(2):217-221.

Walkey

Wiener

Ghobrial

Curtis

Benjamin

. Incident stroke and mortality associated with new-onset atrial fibrillation in patients hospitalized with severe sepsis. Jama. 2011;306(20):2248-2254.

Fuster

Rydén

Cannom

, et al. 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: A report of the American college of cardiology foundation/American heart association task force on practice guidelines. Circulation. 2011;123(10):e269-e367.

Vincent

Jones

David

Olariu

Cadwell

. Frequency and mortality of septic shock in Europe and North America: A systematic review and meta-analysis. Crit Care. 2019;23(1):196.

Vindhyal

Ranka

Acharya

Shah

Gupta

. Impact of underlying congestive heart failure on in-hospital outcomes in patients with septic shock. J Intensive Care Med. 2022;37(7):965–969.

Healthcare Cost and Utilization Project (HCUP). Agency for Healthcare Research and Quality .

Austin

. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res. 2011;46(3):399-424.

10.

Esmon

Lupu

. Innate immunity and coagulation. J Thromb Haemost. 2011;9(Suppl 1):182-188.

11.

Seong

Matzinger

. Hydrophobicity: An ancient damage-associated molecular pattern that initiates innate immune responses. Nat Rev Immunol. 2004;4(6):469-478.

12.

Schouten

Wiersinga

Levi

van der Poll

. Inflammation, endothelium, and coagulation in sepsis. J Leukoc Biol. 2008;83(3):536-545.

13.

Boisramé-Helms

Kremer

Schini-Kerth

Meziani

. Endothelial dysfunction in sepsis. Curr Vasc Pharmacol. 2013;11(2):150-160.

14.

Massion

Feron

Dessy

Balligand

. Nitric oxide and cardiac function: Ten years after, and continuing. Circ Res. 2003;93(5):388-398.

15.

Greer

. Pathophysiology of cardiovascular dysfunction in sepsis. BJA Education. 2015;15(6):316-321.

16.

Aoki

Hatakeyama

Yamamoto

, et al. Role of ion channels in sepsis-induced atrial tachyarrhythmias in guinea pigs. Br J Pharmacol. 2012;166(1):390-400.

17.

Khan

Thomas

Lip

GYH

Shantsila

. Endothelial function in patients with atrial fibrillation. Ann Med. 2020;52(1-2):1-11.

18.

Balik

Matousek

Maly

Brozek

. Management of arrhythmia in sepsis and septic shock. Anaesthesiol Intensive Ther. 2017;49(5):419-429.

19.

Kuipers

Klein Klouwenberg

Cremer

. Incidence, risk factors and outcomes of new-onset atrial fibrillation in patients with sepsis: A systematic review. Crit Care. 2014;18(6):688.

20.

Arrigo

Bettex

Rudiger

. Management of atrial fibrillation in critically ill patients. Crit Care Res Pract. 2014;2014:840615.

21.

Sleeswijk

Van Noord

Tulleken

Ligtenberg

Girbes

Zijlstra

. Clinical review: Treatment of new-onset atrial fibrillation in medical intensive care patients--a clinical framework. Crit Care. 2007;11(6):233.

22.

Badheka

Rathod

Kizilbash

, et al. Comparison of mortality and morbidity in patients with atrial fibrillation and heart failure with preserved versus decreased left ventricular ejection fraction. Am J Cardiol. 2011;108(9):1283-1288.