Atrial Fibrillation and Sepsis in Elderly Patients and Their Associaton with In-Hospital Mortality

Abstract Background Atrial fibrillation (AF) affects about 2% to 4% of the world population, and in patients hospitalized in intensive care units, this incidence can reach up to 23% in those with septic shock. The impact of AF in patients with sepsis is reflected in worse clinical outcomes, and the identification of the triggering factors can be a target for future prevention and treatment strategies. Objectives To verify the relationship between the development of AF and mortality in patients over 80 years of age included in the sepsis protocol and to identify the risk factors that contribute to the development of AF in this population. Methods Retrospective observational study, with a review of electronic medical records and inclusion of 895 patients aged 80 years or older, included in the sepsis protocol of a high-complexity private hospital in São Paulo, SP, from January 2018 to December 2020. All tests were performed with a significance level of 5%. Results The incidence of AF in the sample was 13%. After multivariate analysis, using multiple logistic regression, it was possible to demonstrate an association of mortality, in the studied population, with the SOFA score (odds ratio [OR] 1.21 [1.09 – 1.35]), higher values of C-reactive protein (OR 1.04 [1.01 – 1.06]), need for vasoactive drugs (OR 2.4 [1.38 – 4.18]), use of mechanical ventilation (OR 3.49 [1.82 – 6.71]), and mainly AF (OR 3.7 [2.16 – 6.31]) Conclusion In very elderly patients (80 years of age and older) with sepsis, the development of AF was shown to be an independent risk factor for in-hospital mortality.

**背景** 心房颤动（Atrial fibrillation, AF）在全球人群中的患病率约为2%~4%，而在重症监护病房（intensive care units, ICU）住院患者中，合并感染性休克者的房颤发生率可高达23%。房颤对脓毒症患者的不良影响体现在更差的临床结局中，明确其诱发因素可为未来的防治策略提供干预靶点。
**目的** 本研究旨在验证纳入脓毒症诊疗方案的80岁及以上患者中，房颤发生与院内病死率的关联，并明确该人群中房颤发生的危险因素。
**方法** 本研究为回顾性观察研究，通过回顾电子病历，纳入2018年1月至2020年12月期间，巴西圣保罗州某高复杂度私立医院脓毒症诊疗方案中的895名80岁及以上患者。所有统计检验均采用5%的显著性水平。
**结果** 本研究队列的房颤发生率为13%。经多因素logistic回归分析后，证实研究人群的院内病死率与以下因素显著相关：序贯器官衰竭评分（Sequential Organ Failure Assessment, SOFA，比值比[OR]=1.21，95%置信区间1.09~1.35）、更高的C反应蛋白（C-reactive protein, CRP）水平（OR=1.04，95%置信区间1.01~1.06）、需使用血管活性药物（OR=2.4，95%置信区间1.38~4.18）、机械通气使用需求（OR=3.49，95%置信区间1.82~6.71），其中房颤的关联效应最为显著（OR=3.7，95%置信区间2.16~6.31）。
**结论** 在80岁及以上的老年脓毒症患者中，房颤的发生是院内病死率的独立危险因素。