PURPOSE: Severe sepsis represents a significant healthcare burden. Literature reporting the incidence and outcomes of atrial fibrillation in severe sepsis is limited. Smaller studies have previously reported a higher incidence of AF in severe sepsis, but this has not been systematically studied. We sought to examine the incidence and outcomes of atrial fibrillation in patients with severe sepsis and septic shock using a national database.
METHODS: Using the Nationwide Inpatient Sample 2007, patients aged 18 or more discharged with any primary diagnosis of atrial fibrillation (AF), were identified. The diagnosis of any severe sepsis or septic shock was identified through appropriate ICD-9 codes. Multivariate regression analysis was performed using appropriate survey commands in STATA to find the association between the above arrhythmias and severe sepsis or septic shock. The analysis was adjusted for age, demographics and other relevant co-morbid conditions.
RESULTS: There were 32,751,252 estimated adult discharges in 2007 NIS. Frequency of AF in patient without severe sepsis and septic shock was 3,240,083 (10.0%). The frequency of AF was significantly higher in patients with severe sepsis(OR 1.16;95%CI 1.13-1.19) and septic shock(OR 1.33; 95%CI 1.29-1.37). The adjusted mortality of patient with severe sepsis having AF was significantly higher in those without AF (OR 1.19; 95%CI 1.14-1.24). The adjusted mortality of patient with septic shock having AF was significantly higher in those without AF (OR 1.12; 95%CI 1.07-1.18).
CONCLUSION: Using nationally representative data, this observational study showed that Atrial fibrillation is more common in patients with severe sepsis and septic shock and is an independent risk factor for mortality in this group of patients. Prospective trials are needed to evaluate causal relationships.
CLINICAL IMPLICATIONS: Atrial fibrillation is more frequent in patients with severe sepsis and septic shock and predicts a worse outcome in this group of patients.
DISCLOSURE: Gagan Kumar, No Financial Disclosure Information; No Product/Research Disclosure Information