title: Risk factors and clinical outcomes of arrhythmias in the medical intensive care unit.
abstract: BACKGROUND
  The clinical impact of arrhythmias on the continuum of critical illness is unclear, and data in medical intensive care units (ICU) is lacking. In this study, we distinguish between different types of arrhythmias and evaluate if their distinction is of clinical importance based on ICU length of stay and mortality outcomes.
  
  
  METHODS
  We performed a retrospective analysis of 215 patients in a community-based teaching hospital medical ICU. Variables gathered include sociodemographic data, arrhythmias identified and interpreted by the study team, and admission diagnoses coded into clinical mediator categories based on theorized common risk pathways. Univariable and multivariable Poisson regression models were used to identify risk factors for developing arrhythmias by type, prolonged length of stay, and hospital mortality.
  
  
  RESULTS
  Significant arrhythmia was detected in 28.8 % of subjects with most new arrhythmia events developing within the first 3 days of ICU stay. Acute myocardial ischemia and acute kidney injury at the time of ICU admission were associated with an increased risk of developing supraventricular arrhythmias (SVA) (RR = 2.02; 95 % CI 1.08-3.78 and RR = 1.93; 95 %CI 1.09-3.37, respectively). SVA in the first 3 days of ICU stay was associated with an increased risk of prolonged ICU stay (RR = 1.47; 95 % CI 1.09-1.97). After controlling for clinical mediators, development of SVA was not independently associated with in-hospital mortality. No mediators significantly increased the risk of developing ventricular arrhythmias (VA). VA were not associated to prolonged ICU stay but were associated with increased risk of hospital mortality (RR = 1.93; 95 % CI 1.18-3.15).
  
  
  CONCLUSIONS
  It is important to distinguish between supraventricular and ventricular arrhythmias for outcomes in the medical ICU setting. Developing a new VA increases the risk of in-hospital mortality independently. Developing a new SVA increases the risk of having a prolonged ICU stay but does not appear to increase in-hospital mortality independently. These findings suggest that the development of a VA should be considered an independent morbid event and not necessarily the end result of a complicated clinical course, while a new SVA may be considered a cardiac complication of the disease continuum which may add complexity to an ICU stay.
authors.affiliation: Endocrinology Department, Stanford University, Stanford, CA USA ; Retrovirus Research Center, Universidad Central del Caribe School of Medicine, Bayamón, Puerto Rico ; Department of Medicine, 300 Pasteur Drive, Grant Building, Rm S025, Stanford, CA 94305-5103 USA.
authors.forename: Rodrigo J
authors.initials: RJ
authors.lastname: Valderrábano
authors.affiliation: Medicine Department, Universidad Central del Caribe School of Medicine, Bayamón, Puerto Rico.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Blanco
authors.affiliation: Retrovirus Research Center, Universidad Central del Caribe School of Medicine, Bayamón, Puerto Rico.
authors.forename: Eduardo J
authors.initials: EJ
authors.lastname: Santiago-Rodriguez
authors.affiliation: Retrovirus Research Center, Universidad Central del Caribe School of Medicine, Bayamón, Puerto Rico.
authors.forename: Christine
authors.initials: C
authors.lastname: Miranda
authors.affiliation: Medicine Department, Universidad Central del Caribe School of Medicine, Bayamón, Puerto Rico.
authors.forename: José
authors.initials: J
authors.lastname: Rivera-Del Rio Del Rio
authors.affiliation: Medicine Department, Universidad Central del Caribe School of Medicine, Bayamón, Puerto Rico.
authors.forename: Juan
authors.initials: J
authors.lastname: Ruiz
authors.affiliation: Medicine Department, Universidad Central del Caribe School of Medicine, Bayamón, Puerto Rico ; Retrovirus Research Center, Universidad Central del Caribe School of Medicine, Bayamón, Puerto Rico.
authors.forename: Robert
authors.initials: R
authors.lastname: Hunter