Risk Factors Associated with the Onset of Atrial Fibrillation in Patients with Sepsis and Septic Shock in Intensive Care Units

Abstract

Introduction

New-onset atrial fibrillation (AF) in sepsis is a common complication in critically ill patients and carries significant prognostic implications. Although multiple risk factors have been associated with its development, findings remain inconsistent, and data from Latin American populations are scarce. This study aimed to evaluate the association between clinical variables of sepsis and the development of new-onset atrial fibrillation (AF) in patients admitted to intensive care units (ICUs).

Methods

A retrospective cohort study was conducted across three referral hospitals in Medellín, Colombia, between January 2022 and June 2023. Adult patients admitted to the ICU with a diagnosis of sepsis or septic shock, defined according to the SEPSIS-3 criteria, were included. Infection-related clinical variables were measured, and the primary outcome was the development of new-onset AF. A multivariable analysis was performed using adjusted binomial logistic regression.

Results

A total of 1356 patients were included, with a mean age of 64.3 years; 67.7% were male. The prevalence of new-onset AF was 12.6% (n = 171). In the multivariable analysis higher SOFA scores and the use of noninvasive mechanical ventilation or vasoactive drugs were associated with its development. In the multivariable analysis adjusted for confounding variables, only the use of dual vasopressor support (OR 2.7; 95% CI, 1.1-7.35) and the use of any inotrope (OR 4.02; 95% CI, 1.3-11.65) were significantly associated with the development of AF. Patients who developed AF exhibited higher ICU mortality (49% vs 34%) and in-hospital mortality (55% vs 37%).

Conclusion

New-onset AF in sepsis is common among ICU patients. Use of dual vasopressor support and any inotropic agent were consistently associated with its occurrence.