Huo Yuxin, Yoshimura Hiroyuki, Gonzalez-Izquierdo Arturo, Lip Gregory Y H, Schmidt Floriaan, Providencia Rui
Institute of Health Informatics, University College London, London, United Kingdom.
Institute of Health Informatics, University College London, London, United Kingdom; Centre for Health Data Science, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom.
JACC Adv. 2025 Mar 27;4(4):101681. doi: 10.1016/j.jacadv.2025.101681.
Atrial fibrillation (AF) may occur in patients with sepsis and is associated with a worse prognosis. To date, no UK nationwide studies have investigated the risks and impact of AF and sepsis.
The authors aimed to: 1) identify risk factors contributing to the development of new-onset AF in patients with sepsis; and 2) assess the impact of new-onset AF on in-hospital and long-term outcomes.
Utilizing linked UK-electronic health records of 5.6 million people between 1998 and 2016, we analyzed risk factors for new-onset AF in the setting of sepsis and assessed duration of hospitalization, rate of septic shock, 7- and 30-day in-hospital mortality, postdischarge mortality, and stroke. Cox proportional hazards models were used to assess postdischarge outcomes, and adjustment for behavioral and demographic variables, and comorbid conditions was performed. Fine-Gray analyses were used to account for competing risks.
We identified 7,691 patients hospitalized for sepsis and new-onset AF, 24,506 patients with sepsis who did not develop new-onset AF, and 95,287 patients hospitalized for new-onset AF who did not have sepsis. Age, sex, ethnicity, socioeconomic deprivation, smoking, chronic obstructive pulmonary disease, heart failure, ischemic heart disease, valvular heart disease, and hypertension were significantly associated with new-onset AF. Compared to sepsis patients without AF, those with new-onset AF during sepsis had longer duration of hospitalization, higher risk of developing septic shock, and higher in-hospital mortality. Patients with sepsis and new-onset AF had a higher rate of stroke (adjusted HR: 1.18; 95% CI: 1.08-1.30), heart failure, myocardial infarction, and mortality postdischarge (adjusted HR: 1.07; 95% CI: 1.03-1.12) than those with sepsis without AF.
AF during sepsis is common and is not an innocent finding. Active monitoring should be pursued as AF has important short- and long-term prognostic implications.
脓毒症患者可能发生心房颤动（AF），且与较差的预后相关。迄今为止，英国尚无全国性研究调查AF与脓毒症的风险及影响。
作者旨在：1）确定脓毒症患者新发AF的危险因素；2）评估新发AF对住院及长期预后的影响。
利用1998年至2016年间560万人的英国电子健康记录，我们分析了脓毒症患者新发AF的危险因素，并评估了住院时间、感染性休克发生率、7天和30天住院死亡率、出院后死亡率及卒中情况。采用Cox比例风险模型评估出院后结局，并对行为和人口统计学变量以及合并症进行了调整。使用Fine-Gray分析来处理竞争风险。
我们确定了7691例因脓毒症和新发AF住院的患者、24506例未发生新发AF的脓毒症患者以及95287例因新发AF住院但无脓毒症的患者。年龄、性别、种族、社会经济剥夺、吸烟、慢性阻塞性肺疾病、心力衰竭、缺血性心脏病、瓣膜性心脏病和高血压与新发AF显著相关。与无AF的脓毒症患者相比，脓毒症期间发生新发AF的患者住院时间更长，发生感染性休克的风险更高，住院死亡率更高。与无AF的脓毒症患者相比，脓毒症合并新发AF的患者卒中发生率（校正HR：1.18；95%CI：1.08 - 1.30）、心力衰竭、心肌梗死及出院后死亡率（校正HR：1.07；95%CI：1.03 - 1.12）更高。
脓毒症期间的AF很常见，并非无害发现。由于AF具有重要的短期和长期预后意义，应进行积极监测。
