title: Incident stroke and mortality associated with new-onset atrial fibrillation in patients hospitalized with severe sepsis.
abstract: BACKGROUND
  New-onset atrial fibrillation (AF) has been reported in 6% to 20% of patients with severe sepsis. Chronic AF is a known risk factor for stroke and death, but the clinical significance of new-onset AF in the setting of severe sepsis is uncertain.
  
  
  OBJECTIVE
  To determine the in-hospital stroke and in-hospital mortality risks associated with new-onset AF in patients with severe sepsis.
  
  
  METHODS
  Retrospective population-based cohort of California State Inpatient Database administrative claims data from nonfederal acute care hospitals for January 1 through December 31, 2007.
  
  
  METHODS
  Data were available for 3,144,787 hospitalized adults. Severe sepsis (n = 49,082 [1.56%]) was defined by validated International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 995.92. New-onset AF was defined as AF that occurred during the hospital stay, after excluding AF cases present at admission.
  
  
  METHODS
  A priori outcome measures were in-hospital ischemic stroke (ICD-9-CM codes 433, 434, or 436) and mortality.
  
  
  RESULTS
  Patients with severe sepsis were a mean age of 69 (SD, 16) years and 48% were women. New-onset AF occurred in 5.9% of patients with severe sepsis vs 0.65% of patients without severe sepsis (multivariable-adjusted odds ratio [OR], 6.82; 95% CI, 6.54-7.11; P < .001). Severe sepsis was present in 14% of all new-onset AF in hospitalized adults. Compared with severe sepsis patients without new-onset AF, patients with new-onset AF during severe sepsis had greater risks of in-hospital stroke (75/2896 [2.6%] vs 306/46,186 [0.6%] strokes; adjusted OR, 2.70; 95% CI, 2.05-3.57; P < .001) and in-hospital mortality (1629 [56%] vs 18,027 [39%] deaths; adjusted relative risk, 1.07; 95% CI, 1.04-1.11; P < .001). Findings were robust across 2 definitions of severe sepsis, multiple methods of addressing confounding, and multiple sensitivity analyses.
  
  
  CONCLUSIONS
  Among patients with severe sepsis, patients with new-onset AF were at increased risk of in-hospital stroke and death compared with patients with no AF and patients with preexisting AF.
authors.affiliation: Pulmonary Center, Division of Pulmonary and Critical Care Medicine, Boston University School of Medicine, R-304, Boston, MA 02118, USA. alwalkey@bu.edu
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Walkey
authors.forename: Renda Soylemez
authors.initials: RS
authors.lastname: Wiener
authors.forename: Joanna M
authors.initials: JM
authors.lastname: Ghobrial
authors.forename: Lesley H
authors.initials: LH
authors.lastname: Curtis
authors.forename: Emelia J
authors.initials: EJ
authors.lastname: Benjamin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000209:etiology* / Q000401:mortality*; D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000150:complications / Q000401:mortality*; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology*
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