Prediction of new-onset atrial fibrillation with the CHEST score in patients admitted with community-acquired pneumonia.

PURPOSE

Patients hospitalized for community-acquired pneumonia (CAP) may have a higher risk of new-onset atrial fibrillation (NOAF). The CHEST score was developed to evaluate the NOAF risk in the general population. Data on the value of the CHEST score in acute patients admitted with CAP are lacking. We want to establish the predictive value of CHEST score for NOAF in patients with CAP.

METHODS

Patients with CAP enrolled in the SIXTUS cohort were enrolled. CHEST score was calculated at baseline. In-hospital NOAF was recorded. Receiver-operating Characteristic (ROC) curve and multivariable Cox proportional hazard regression analysis were performed.

RESULTS

We enrolled 473 patients (36% women, mean age 70.6 ± 16.5 years), and 54 NOAF occurred. Patients with NOAF were elderly, more frequently affected by hypertension, heart failure, previous stroke/transient ischemic attack, peripheral artery disease and hyperthyroidism. NOAF patients had also higher CURB-65, PSI class and CHADS-VASc score. The C-index of CHEST score for NOAF was 0.747 (95% confidence interval [95%CI] 0.705-0.786), higher compared to CURB-65 (0.611, 95%CI 0.566-0.655, p = 0.0016), PSI (0.665, 95%CI 0.621-0.708, p = 0.0199) and CHADS-VASc score (0.696, 95%CI 0.652-0.737, p = 0.0762). The best combination of sensitivity (67%) and specificity (70%) was observed with a CHEST score ≥ 4. This result was confirmed by the multivariable Cox analysis (Hazard Ratio [HR] for CHEST score ≥ 4 was 10.7, 95%CI 2.0-57.9; p = 0.006), independently from the severity of pneumonia.

CONCLUSION

The CHEST score was a useful predictive tool to identify patients at higher risk for NOAF during hospitalization for CAP.

CLINICAL TRIAL REGISTRATION

www.

CLINICALTRIALS

gov (NCT01773863).