Walkey Allan J, Hammill Bradley G, Curtis Lesley H, Benjamin Emelia J
From the Pulmonary Center and the Section of Pulmonary and Critical Care Medicine, Boston University School of Public Health, Boston, MA.
Sections of Cardiovascular Medicine and Preventive Medicine, Department of Medicine, and the Department of Epidemiology, Boston University School of Public Health, Boston, MA.
Chest. 2014 Nov;146(5):1187-1195. doi: 10.1378/chest.14-0003.
New-onset atrial fibrillation (AF) is associated with adverse outcomes during a sepsis hospitalization; however, long-term outcomes following hospitalization with sepsis-associated new-onset AF are unclear.
We used a Medicare 5% sample to identify patients who survived hospitalization with sepsis between 1999 and 2010. AF status was defined as no AF, prior AF, or new-onset AF based on AF claims during and prior to a sepsis hospitalization. We used competing risk models to determine 5-year risks of AF occurrence, heart failure, ischemic stroke, and mortality after the sepsis hospitalization, according to AF status during the sepsis admission.
We identified 138,722 sepsis survivors, of whom 95,536 (69%) had no AF during sepsis, 33,646 (24%) had prior AF, and 9,540 (7%) had new-onset AF during sepsis. AF occurrence following sepsis hospitalization was more common among patients with new-onset AF during sepsis (54.9%) than in patients with no AF during sepsis (15.5%). Compared with patients with no AF during sepsis, those with new-onset AF during sepsis had greater 5-year risks of hospitalization for heart failure (11.2% vs 8.2%; multivariable-adjusted hazard ratio [HR], 1.25; 95% CI, 1.16-1.34), ischemic stroke (5.3% vs 4.7%; HR, 1.22; 95% CI, 1.10-1.36), and death (74.8% vs 72.1%; HR, 1.04; 95% CI,1.01-1.07).
Most sepsis survivors with new-onset AF during sepsis have AF occur after discharge from the sepsis hospitalization and have increased long-term risks of heart failure, ischemic stroke, and death. Our findings may have implications for posthospitalization surveillance of patients with new-onset AF during a sepsis hospitalization.
新发房颤（AF）与脓毒症住院期间的不良预后相关；然而，脓毒症相关新发房颤患者住院后的长期预后尚不清楚。
我们使用医疗保险5%的样本，确定1999年至2010年间脓毒症住院存活的患者。根据脓毒症住院期间及之前的房颤索赔情况，房颤状态定义为无房颤、既往房颤或新发房颤。我们使用竞争风险模型，根据脓毒症入院时的房颤状态，确定脓毒症住院后房颤发生、心力衰竭、缺血性中风和死亡的5年风险。
我们确定了138722名脓毒症幸存者，其中95536名（69%）在脓毒症期间无房颤，33646名（24%）有既往房颤，9540名（7%）在脓毒症期间有新发房颤。脓毒症住院后房颤发生在脓毒症期间新发房颤患者中（54.9%）比脓毒症期间无房颤患者中（15.5%）更常见。与脓毒症期间无房颤患者相比，脓毒症期间新发房颤患者发生心力衰竭住院的5年风险更高（11.2%对8.2%；多变量调整风险比[HR]，1.25；95%CI，1.16 - 1.34）、缺血性中风（5.3%对4.7%；HR，1.22；95%CI，1.10 - 1.36）和死亡（74.8%对72.1%；HR，1.04；95%CI，1.01 - 1.07）。
大多数脓毒症期间新发房颤的幸存者在脓毒症住院出院后发生房颤，并且心力衰竭、缺血性中风和死亡的长期风险增加。我们的研究结果可能对脓毒症住院期间新发房颤患者的出院后监测有影响。
