title: Impact of Low-Dose Hydrocortisone on the Incidence of Atrial Fibrillation in Patients With Septic Shock: A Propensity Score-Inverse Probability of Treatment Weighting Cohort Study.
abstract: OBJECTIVE
  Atrial fibrillation (AF) is common in the intensive care unit (ICU), notably in patients with septic shock for whom inflammation is an already identified risk factor. The aim of this study was to evaluate the effect of low-dose hydrocortisone on AF occurrence in patients with septic shock.
  
  
  METHODS
  We performed a prospective nonrandomized observational study in 5 academic ICUs in France. From November 2012 to June 2014, all patients ≥16 years having septic shock were included, except those who had a history of AF, had a pacemaker, and/or experienced AF during hospitalization before the onset of shock or in whom the onset of shock occurred prior to admission to the ICU. Hydrocortisone was administered at the discretion of the attending physician. The incidence of AF was compared among patients who received hydrocortisone, and the effect of low-dose hydrocortisone on AF was estimated using the inverse probability treatment weighting method based on propensity scores.
  
  
  RESULTS
  A total of 261 patients were included (no-hydrocortisone group, n = 138; hydrocortisone group, n = 123). Atrial fibrillation occurred in 57 (22%) patients. Atrial fibrillation rates were 33 (24%) and 24 (19%) in no-hydrocortisone patients and hydrocortisone patients, respectively. In the weighted sample, the proportion of patients who developed AF was 28.8% in the no-hydrocortisone group and 16.8% in the hydrocortisone group (difference: -11.9%; 95% confidence interval: -23.4% to -0.5%;P= .040).
  
  
  CONCLUSIONS
  In patients with septic shock, low-dose hydrocortisone was associated with a lower risk of developing AF during the acute phase.
authors.affiliation: Service d'Anesthésie Réanimation 1, CHU Rennes, Hôpital Pontchaillou, Rennes, France.
authors.forename: Yoann
authors.initials: Y
authors.lastname: Launey
authors.affiliation: Département d'Anesthésie Réanimation, CHU Angers, Angers, France.
authors.forename: Sigismond
authors.initials: S
authors.lastname: Lasocki
authors.affiliation: Département d'Anesthésie Réanimation, CHU Nantes, Nantes, France.
authors.forename: Karim
authors.initials: K
authors.lastname: Asehnoune
authors.affiliation: Service d'Anesthésie Réanimation 1, CHU Rennes, Hôpital Pontchaillou, Rennes, France.
authors.forename: Baptiste
authors.initials: B
authors.lastname: Gaudriot
authors.affiliation: Département d'Anesthésie Réanimation, CHU Angers, Angers, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Chassier
authors.affiliation: Département d'Anesthésie Réanimation, CHU Nantes, Nantes, France.
authors.forename: Raphael
authors.initials: R
authors.lastname: Cinotti
authors.affiliation: Département d'Anesthésie Réanimation, CHU Brest, Brest, France.
authors.forename: Pascale Le
authors.initials: PL
authors.lastname: Maguet
authors.affiliation: Département d'Anesthésie Réanimation, CHU Poitiers, Poitiers, France.
authors.forename: Leila
authors.initials: L
authors.lastname: Laksiri
authors.affiliation: Département d'Anesthésie Réanimation, CHU Poitiers, Poitiers, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Mimoz
authors.affiliation: Service d'Anesthésie Réanimation 1, CHU Rennes, Hôpital Pontchaillou, Rennes, France.
authors.forename: Audrey
authors.initials: A
authors.lastname: Tawa
authors.affiliation: Service d'Anesthésie Réanimation 1, CHU Rennes, Hôpital Pontchaillou, Rennes, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Nesseler
authors.affiliation: Service d'Anesthésie Réanimation 1, CHU Rennes, Hôpital Pontchaillou, Rennes, France.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Malledant
authors.affiliation: EA 4275 SPHERE "Biostatistics, Pharmacoepidemiology and Human Science Research," UFR des Sciences Pharmaceutiques, Université de Nantes, Nantes, France.
authors.forename: Bastien
authors.initials: B
authors.lastname: Perrot
authors.affiliation: Service d'Anesthésie Réanimation 1, CHU Rennes, Hôpital Pontchaillou, Rennes, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Seguin
mesh_terms: D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D005602:France / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D011446:Prospective Studies; D065840:Protective Factors; D012772:Shock, Septic / Q000188:drug therapy*
chemical_list: D000893:Anti-Inflammatory Agents; D006854:Hydrocortisone
keywords: atrial fibrillation; critical care; sepsis; shock