In the Journals

New AF may signal sepsis onset

Links between new-onset atrial fibrillation and mortality suggest that the condition may serve as a measure of cardiac dysfunction during sepsis, according to a study published in the Annals of the American Thoracic Society.

The Sepsis-3 task force defines sepsis as life-threatening organ dysfunction in response to infection, which is evaluated using the Sequential Organ Failure Assessment (SOFA) score. Currently, the SOFA score measures cardiac dysfunction using blood pressure and vasopressor dose only.

“However, the extent to which other potential measures of cardiac dysfunction with plausible sepsis-related mechanisms, such as new-onset AF, may improve prognostication consistent with the conceptual model of Sepsis-3, is unclear,” the researchers wrote.

To determine whether AF could add value to sepsis assessment, the researchers evaluated the predictive ability of new-onset AF, the change in net reclassification improvement after adding AF to the Sepsis-3 model and the number of SOFA points that new-onset AF may represent if considered a form of sepsis-associated cardiac dysfunction.

Results showed that 2.5% of 9,528 patients with suspected infection developed new-onset AF after admission to the ICU.

Patients with new-onset AF appeared to be more likely to die in the hospital in both an unadjusted model (OR = 2.54; 95% CI, 1.94-3.32) and when added to the Sepsis-3 model (beta coefficient = 0.58; OR = 1.78; 95% CI, 1.34-2.38). A similar association between new-onset AF and hospital mortality risk was seen with each 1-point increase in the maximum SOFA score in both an unadjusted model (OR = 1.18; 95% CI, 1.16-1.2) and in the Sepsis-3 model (beta coefficient = 0.16; OR = 1.18; 95% CI, 1.16-1.19).

The researchers also observed a 1.3% improvement in the net reclassification improvement for hospital mortality with the addition of new-onset AF to the Sepsis-3 model. The links between new-onset AF and mortality were similar in patients with cardiovascular SOFA scores less than 2 (OR = 1.72; 95% CI, 1.14-2.59) or at least 2 (OR = 2.41; 95% CI, 1.63-3.56; P for interaction = .21).

Additionally, the beta coefficient of new-onset AF decreased by 13.7% with the addition of the CV SOFA score to the unadjusted model and decreased by less than 10% with addition of the other SOFA components.

“Our findings suggest that new-onset AF during suspected infection meets the Sepsis-3 conceptual criteria of an acute organ (cardiac) dysfunction associated with a high risk of mortality,” the researchers wrote, adding that new-onset AF was associated with increased mortality that was comparable to an approximately 4-point increase in SOFA score.

“Given plausible mechanisms linking infection to new-onset AF, and the high risk of death among patients with new-onset AF and suspected infection, we suggest that future sepsis investigators continue to explore new-onset AF as a potentially sepsis-defining sign of cardiac dysfunction.” – by Melissa Foster

Disclosures: The authors report no relevant financial disclosures.

Links between new-onset atrial fibrillation and mortality suggest that the condition may serve as a measure of cardiac dysfunction during sepsis, according to a study published in the Annals of the American Thoracic Society.

The Sepsis-3 task force defines sepsis as life-threatening organ dysfunction in response to infection, which is evaluated using the Sequential Organ Failure Assessment (SOFA) score. Currently, the SOFA score measures cardiac dysfunction using blood pressure and vasopressor dose only.

“However, the extent to which other potential measures of cardiac dysfunction with plausible sepsis-related mechanisms, such as new-onset AF, may improve prognostication consistent with the conceptual model of Sepsis-3, is unclear,” the researchers wrote.

To determine whether AF could add value to sepsis assessment, the researchers evaluated the predictive ability of new-onset AF, the change in net reclassification improvement after adding AF to the Sepsis-3 model and the number of SOFA points that new-onset AF may represent if considered a form of sepsis-associated cardiac dysfunction.

Results showed that 2.5% of 9,528 patients with suspected infection developed new-onset AF after admission to the ICU.

Patients with new-onset AF appeared to be more likely to die in the hospital in both an unadjusted model (OR = 2.54; 95% CI, 1.94-3.32) and when added to the Sepsis-3 model (beta coefficient = 0.58; OR = 1.78; 95% CI, 1.34-2.38). A similar association between new-onset AF and hospital mortality risk was seen with each 1-point increase in the maximum SOFA score in both an unadjusted model (OR = 1.18; 95% CI, 1.16-1.2) and in the Sepsis-3 model (beta coefficient = 0.16; OR = 1.18; 95% CI, 1.16-1.19).

The researchers also observed a 1.3% improvement in the net reclassification improvement for hospital mortality with the addition of new-onset AF to the Sepsis-3 model. The links between new-onset AF and mortality were similar in patients with cardiovascular SOFA scores less than 2 (OR = 1.72; 95% CI, 1.14-2.59) or at least 2 (OR = 2.41; 95% CI, 1.63-3.56; P for interaction = .21).

Additionally, the beta coefficient of new-onset AF decreased by 13.7% with the addition of the CV SOFA score to the unadjusted model and decreased by less than 10% with addition of the other SOFA components.

“Our findings suggest that new-onset AF during suspected infection meets the Sepsis-3 conceptual criteria of an acute organ (cardiac) dysfunction associated with a high risk of mortality,” the researchers wrote, adding that new-onset AF was associated with increased mortality that was comparable to an approximately 4-point increase in SOFA score.

“Given plausible mechanisms linking infection to new-onset AF, and the high risk of death among patients with new-onset AF and suspected infection, we suggest that future sepsis investigators continue to explore new-onset AF as a potentially sepsis-defining sign of cardiac dysfunction.” – by Melissa Foster

Disclosures: The authors report no relevant financial disclosures.