Mattia Arrigo1, Shiro Ishihara2, Elodie Feliot2, Alain Rudiger3, Nicolas Deye4, Alain Cariou5, Bertrand Guidet6, Samir Jaber7, Marc Leone8, Matthieu Resche-Rigon9, Antoine Vieillard Baron10, Matthieu Legrand11, Etienne Gayat12, Alexandre Mebazaa13. 1. Department of Anaesthesiology and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals and INSERM UMR-S 942, Paris, France; Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland. Electronic address: mattia.arrigo@usz.ch. 2. Department of Anaesthesiology and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals and INSERM UMR-S 942, Paris, France. 3. Cardiosurgical Intensive Care Unit, Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland. Electronic address: alain.rudiger@usz.ch. 4. Department of Anaesthesiology and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals and INSERM UMR-S 942, Paris, France. Electronic address: nicolas.deye@aphp.fr. 5. Medical Intensive Care Unit, AP-HP, Hôpital Cochin, Paris, France. Electronic address: alain.cariou@aphp.fr. 6. Medical Intensive Care Unit, AP-HP, Hôpital Saint-Antoine and INSERM UMR-S 1136, Paris, France. Electronic address: betrand.guidet@aphp.fr. 7. Department of Anaesthesiology and Critical Care Medicine, Saint-Eloi University Hospital, Montpellier, France. Electronic address: s-jaber@chu-montpellier.fr. 8. Department of Anaesthesiology and Critical Care Medicine, AP-HM, Hôpital Nord, Marseille, France. Electronic address: marc.leone@ap-hm.fr. 9. SBIM, Biostatistics and Clinical Epidemiology Research Unit Department, AP-HP, Saint Louis University Hospital, Paris, France. Electronic address: matthieu.resche-rigon@univ-paris-diderot.fr. 10. Department of Anesthesiology and Critical Care Medicine, AP-HP, Hôpital Ambroise Paré, Paris, France. Electronic address: antoine.vieillard-baron@aphp.fr. 11. Department of Anaesthesiology and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals and INSERM UMR-S 942, Paris, France. Electronic address: matthieu.legrand@aphp.fr. 12. Department of Anaesthesiology and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals and INSERM UMR-S 942, Paris, France. Electronic address: etienne.gayat@aphp.fr. 13. Department of Anaesthesiology and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals and INSERM UMR-S 942, Paris, France. Electronic address: alexandre.mebazaa@aphp.fr.
Abstract
BACKGROUND: Atrial fibrillation (AFib) is associated with adverse outcome in critical illness, but whether this effect is independent from other risk factors remains uncertain. New-onset AFib during critical illness may be independently associated with increased in-hospital and long-term risk of death. METHODS: FROG-ICU was a prospective, observational, multi-centre cohort study designed to investigate the outcome of critically ill patients. Inclusion criteria were invasive mechanical ventilation and/or treatment with a positive inotropic agent for >24 h. Heart rhythm was assessed at inclusion and during ICU stay with digital ECG recordings. Among patients who had AFib during ICU stay, new-onset and recurrent AFib were diagnosed in patients without and with previous history of AFib, respectively. Primary endpoint was in-hospital mortality; secondary endpoint was 1-year mortality among ICU survivors. RESULTS: The study included 1841 critically ill patients. During ICU stay, AFib occurred in 343 patients (19%). New-onset AFib (n = 212) had higher in-hospital mortality compared to no AFib (47 vs. 23%, P < 0.001) or recurrent AFib (34%, P = 0.032). New-onset AFib showed increased risk of in-hospital death after multivariable adjustment compared to no AFib (OR 1.6, P = 0.003) or recurrent AFib (OR 1.8, P = 0.02). Among the 1464 ICU-survivors, new-onset AFib during ICU stay showed higher post-ICU risk of death compared to no AFib (HR 2.2, P < 0.001). After multivariable adjustment, new-onset AFib showed higher post-ICU risk of death compared to no AFib (HR 1.6, P = 0.03). CONCLUSION: New-onset AFib is independently associated with in-hospital and post-ICU risk of death in critically ill patients.
BACKGROUND:Atrial fibrillation (AFib) is associated with adverse outcome in critical illness, but whether this effect is independent from other risk factors remains uncertain. New-onset AFib during critical illness may be independently associated with increased in-hospital and long-term risk of death. METHODS: FROG-ICU was a prospective, observational, multi-centre cohort study designed to investigate the outcome of critically illpatients. Inclusion criteria were invasive mechanical ventilation and/or treatment with a positive inotropic agent for >24 h. Heart rhythm was assessed at inclusion and during ICU stay with digital ECG recordings. Among patients who had AFib during ICU stay, new-onset and recurrent AFib were diagnosed in patients without and with previous history of AFib, respectively. Primary endpoint was in-hospital mortality; secondary endpoint was 1-year mortality among ICU survivors. RESULTS: The study included 1841 critically illpatients. During ICU stay, AFib occurred in 343 patients (19%). New-onset AFib (n = 212) had higher in-hospital mortality compared to no AFib (47 vs. 23%, P < 0.001) or recurrent AFib (34%, P = 0.032). New-onset AFib showed increased risk of in-hospital death after multivariable adjustment compared to no AFib (OR 1.6, P = 0.003) or recurrent AFib (OR 1.8, P = 0.02). Among the 1464 ICU-survivors, new-onset AFib during ICU stay showed higher post-ICU risk of death compared to no AFib (HR 2.2, P < 0.001). After multivariable adjustment, new-onset AFib showed higher post-ICU risk of death compared to no AFib (HR 1.6, P = 0.03). CONCLUSION: New-onset AFib is independently associated with in-hospital and post-ICU risk of death in critically illpatients.
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