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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DOI：
10.1001/jama.2011.1615
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发表时间：
2011-11-23
影响因子：
120.7
通讯作者：
Benjamin, Emelia J.
中科院分区：
文献类型：
--
作者：
Walkey, Allan J.;Wiener, Renda Soylemez;Ghobrial, Joanna M.;Curtis, Lesley H.;Benjamin, Emelia J.
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. To determine the in-hospital stroke and in-hospital mortality risks associated with new-onset AF in patients with severe sepsis. Retrospective population-based cohort of California State Inpatient Database administrative claims data from 1/1/2007 through 12/31/2007. Non-Federal acute care hospitals. 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. A priori outcome measures were in-hospital ischemic stroke (ICD-9-CM codes of 433, 434, or 436) and mortality. 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. 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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影响因子：
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作者：
Glazer, Nicole L.;Dublin, Sascha;Heckbert, Susan R.
通讯作者：
Heckbert, Susan R.
影响因子：
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DOI：
10.1164/rccm.200701-031oc
发表时间：
2008-07-01
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