Electrocardiographic risk factors of new-onset atrial fibrillation among critically ill patients with sepsis: a case-referent study
Ambrus, Daniel Balint
MetadataShow full item record
BACKGROUND: Atrial fibrillation (AF) that occurs during acute critical illnesses such as sepsis may have different risk factors than AF that occurs in the community setting. METHODS: We investigated associations between baseline electrocardiographic (ECG) parameters related to conduction, ischemia, and chamber size and new-onset AF that occurs in the setting of severe sepsis in a matched case-referent study. We matched 100 patients with new-onset AF during sepsis to 300 patients with similar age (plus or minus 5 years) who were hospitalized within Boston Medical Center intensive care units (ICU) between 2003-2009 with sepsis. Variables that were found to be significant (p<0.05) during conditional univariable logistic regression were entered into age, sex and race-adjusted conditional logistic regression in order to identify risk factors for new-onset AF during sepsis. RESULTS: Among 100 case and 300 referent patients with sepsis, the distribution of mean age was 69 +/-11 years vs. 71 +/- 11 years, sex was 42% female vs. 49% female, and race was 56% white and 33% black vs. 65% white and 21% black between cases and referents, respectively. Univariable analysis revealed that older age per year [OR 1.25 95% CI (1.07-1.46), p<0.01], longer PR interval per millisecond [168 +/- 43 ms vs. 157 +/- 30 ms; OR 1.01 95% CI (1.00-1.02), p=0.02], and presence of left bundle branch block (LBBB) [9 (9%) vs. 7 (2.3%); OR 4.42 95% CI (1.45-13.5), p<0.01] were significant risk factors among the new-AF cases. Our multivariable model found significant associations between new-onset AF during hospitalization and presence of prolonged PR interval per millisecond [OR 1.01 95% CI (1.00-1.02), p=0.04] and LBBB [OR 6.83 95% CI (1.68-27.8), p=0.01] on ICU admission ECG. CONCLUSION: Increased PR interval length and LBBB found on a 12-lead ECG upon ICU admission was associated with new-onset AF during hospitalization in the setting of sepsis.
Thesis (M.S.M.) PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at firstname.lastname@example.org. Thank you.