Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, GA.
Division of Cardiology, Morehouse School of Medicine, Atlanta, GA.
Crit Care Med. 2019 Aug;47(8):e630-e638. doi: 10.1097/CCM.0000000000003806.
Atrial fibrillation is frequently seen in sepsis-related hospitalizations. However, large-scale contemporary data from the United States comparing outcomes among sepsis-related hospitalizations with versus without atrial fibrillation are limited. The aim of our study was to assess the frequency of atrial fibrillation and its impact on outcomes of sepsis-related hospitalizations.
Retrospective cohort study.
The National Inpatient Sample databases (2010-2014).
Primary discharge diagnosis of sepsis with and without atrial fibrillation were identified using prior validated International Classification of Diseases, 9th Edition, Clinical Modification codes.
None.
Overall, 5,808,166 hospitalizations with the primary diagnosis of sepsis, of which 19.4% (1,126,433) were associated with atrial fibrillation. The sepsis-atrial fibrillation cohort consisted of older (median [interquartile range] age of 79 yr [70-86 yr] vs 67 yr [53-79 yr]; p < 0.001) white (80.9% vs 68.8%; p < 0.001) male (51.1% vs 47.5%; p < 0.001) patients with an extended length of stay (median [interquartile range] 6 d [4-11 d] vs 5 d [3-9 d]; p < 0.001) and higher hospitalization charges (median [interquartile range] $44,765 [$23,234-$88,657] vs $35,737 [$18,767-$72,220]; p < 0.001) as compared with the nonatrial fibrillation cohort. The all-cause mortality rate in the sepsis-atrial fibrillation cohort was significantly higher (18.4% and 11.9%; p = 0.001) as compared with those without atrial fibrillation. Although all-cause mortality (20.4% vs 16.6%) and length of stay (median [interquartile range] 7 d [4-11 d] vs 6 d [4-10 d]) decreased between 2010 and 2014, hospitalization charges increased (median [interquartile range] $41,783 [$21,430-$84,465] vs $46,251 [$24,157-$89,995]) in the sepsis-atrial fibrillation cohort. The greatest predictors of mortality in the atrial fibrillation-sepsis cohort were African American race, female gender, advanced age, and the presence of medical comorbidities.
The presence of atrial fibrillation among sepsis-related hospitalizations is a marker of poor prognosis and increased mortality. Although we observed rising trends in sepsis and sepsis-atrial fibrillation-related hospitalizations during the study period, the rate and odds of mortality progressively decreased.
心房颤动在与脓毒症相关的住院患者中较为常见。然而，目前美国缺乏将与脓毒症相关的住院患者中有无心房颤动的结局进行大规模比较的当代数据。本研究旨在评估心房颤动的发生频率及其对与脓毒症相关的住院患者结局的影响。
回顾性队列研究。
国家住院患者样本数据库（2010-2014 年）。
使用先前验证过的国际疾病分类，第 9 版，临床修正版代码，确定主要诊断为脓毒症且伴有或不伴有心房颤动的患者。
无。
总体而言，5808166 例以脓毒症为主要诊断的住院患者中，19.4%（1126433 例）与心房颤动相关。脓毒症合并心房颤动组患者年龄更大（中位数[四分位距]为 79 岁[70-86 岁]比 67 岁[53-79 岁]；p<0.001），白人（80.9%比 68.8%；p<0.001），男性（51.1%比 47.5%；p<0.001）比例较高，住院时间延长（中位数[四分位距]为 6 d[4-11 d]比 5 d[3-9 d]；p<0.001），住院费用更高（中位数[四分位距]为 44765 美元[23234-88657 美元]比 35737 美元[18767-72220 美元]；p<0.001），与无心房颤动组相比。心房颤动组的全因死亡率明显更高（18.4%和 11.9%；p=0.001）。尽管全因死亡率（20.4%比 16.6%）和住院时间（中位数[四分位距]为 7 d[4-11 d]比 6 d[4-10 d]）在 2010 年至 2014 年间有所下降，但心房颤动组的住院费用增加（中位数[四分位距]为 41783 美元[21430-84465 美元]比 46251 美元[24157-89995 美元]）。心房颤动合并脓毒症组患者死亡率的最大预测因素是非洲裔美国人、女性、高龄和合并存在医疗合并症。
与脓毒症相关的住院患者中存在心房颤动是预后不良和死亡率增加的标志。尽管我们在研究期间观察到脓毒症和脓毒症合并心房颤动相关住院人数呈上升趋势，但死亡率的发生率和比值呈下降趋势。
