A retrospective study on the effects of illness severity and atrial fibrillation on outcomes in the intensive care unit

Quasim, T. , Williams, C., Riddell, L., Rankin, A.C. and Kinsella, J. (2013) A retrospective study on the effects of illness severity and atrial fibrillation on outcomes in the intensive care unit. International Journal of Intensive Care, 20(4), pp. 119-122.

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Abstract

Introduction: Atrial fibrillation (AF) is common in patients in the intensive care unit (ICU) and has been associated with worse outcomes. However, it is unclear whether AF itself adds to the risk of death or is merely a marker of illness severity. We aimed to record the incidence and outcomes of all patients with different categories of AF and determine whether AF was an independent predictor of death.<p></p> Methods: This retrospective cohort study was undertaken in the ICU of a tertiary-referral university hospital. Category of AF, sex, C-reactive protein (CRP) level, APACHE II score, predicted hospital mortality and survival outcomes were analysed from 1084 records. Percentages, medians and interquartile ranges were used to describe the sample. Chi-square test and the non-parametric Mann–Whitney U test were used, as appropriate, for statistical analysis. Logistic regression analyses were performed to evaluate the association of AF with death in the ICU adjusting for age, sex, CRP level and APACHE II score.<p></p> Results: Overall, 13.6% of patients developed new-onset AF during their critical illness, while 4.3% had a pre-existing history. The hospital mortality rate was higher in those with AF compared with those without (47.9% vs. 30.9%, p<0.001) and higher in those with newly diagnosed AF compared with those with a prior history (53.1% vs. 31.9%, p=0.012). CRP levels were higher in those with AF (p<0.001) compared with those without and higher in those with newly diagnosed AF compared with those with a prior history (p=0.012). On multivariate logistic regression analysis, only the APACHE II score was found to be an independent predictor of death.<p></p> Conclusion: Despite the higher mortality rate in patients with AF, the APACHE II score was the only independent predictor of death within the ICU. Prospective studies are required to explore the apparently reduced risk of dying among those with a prior history of AF.<p></p>

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Williams, Miss Claire and Quasim, Dr Tara and Kinsella, Professor John
Authors: Quasim, T., Williams, C., Riddell, L., Rankin, A.C., and Kinsella, J.
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:International Journal of Intensive Care
Publisher:Greycoat Publishing
ISSN:1350-2794
Copyright Holders:Copyright © 2013 Greycoat Publishing
First Published:First published in International Journal of Intensive Care 20(4):119-122
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher.

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