MO397THE IMPACT OF NEW-ONSET ATRIAL FIBRILLATION ON ADVERSE OUTCOMES IN PATIENTS WITH SEPSIS-INDUCED ACUTE KIDNEY INJURY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Zorica Dimitrijevic ◽  
Branka Mitic ◽  
Sonja Salinger ◽  
Goran Paunovic ◽  
Stevan Glogovac ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Acute Kidney Injury ◽  
Univariate Analysis ◽  
Kidney Injury ◽  
Adverse Outcomes ◽  
Intermittent Hemodialysis ◽  
Replacement Treatment ◽  
Number Of Patients ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract Background and Aims The mortality of septic patients with acute kidney injury (s-AKI) prevails high. Atrial fibrillation is commonly observed in the setting of systemic inflammation or infection. The study aimed to assess the incidence and predictors of new-onset atrial fibrillation (NOAF) in this population and its impact on intrahospital mortality. Method We conducted a retrospective cohort study of 462 patients admitted to our unit for s-AKI between January 2016 and December 2020. NOAF was defined as AF discovered during hospitalization in patients with sinus rhythm on admission. Subjects were classified into NOAF (n=68) and non-NOAF groups (n=364). There were no major differences in sepsis severity between groups, and all patients underwent intermittent hemodialysis as a renal replacement treatment modality. Results The NOAF incidence in the whole s-AKI population was 14.7%. In a univariate analysis, age (72.4 in patients with NOAF vs. 62.1 years in patients without NOAF, respectively; p=0.018), male gender (33.5 vs. 14.6%; p= 0.004), history of coronary disease (23.5 vs. 6.1%; p=0.07) and vasopressor medication use (19.0 vs. 8.2%; p = 0.002) were associated with NOAF. 116 (25.1%) patients died during the hospitalization, while 346 patients (74.9%) were discharged from the hospital. NOAF occurring in s-AKI was independently associated with an increased hazard of intrahospital death (HR: 1.36; 95% CI: 1.09–1.51), compared to the non-NOAF group. Conclusion A clinically significant number of patients hospitalized for s-AKI have NOAF, and it is associated with poor hospital outcomes.

New-onset atrial fibrillation in patients with acute kidney injury on continuous renal replacement therapy

2021 ◽  
Vol 62 ◽  
pp. 157-163
Author(s):  
Khaled Shawwa ◽  
Panagiotis Kompotiatis ◽  
Shane A. Bobart ◽  
Kristin C. Mara ◽  
Brandon M. Wiley ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Onset Atrial Fibrillation ◽  
New Onset

New-onset atrial fibrillation and warfarin initiation: High risk periods and implications for new antithrombotic drugs

2010 ◽  
Vol 104 (12) ◽  
pp. 1099-1105 ◽  
Author(s):  
Renato D. Lopes ◽  
Elaine M. Hylek ◽  
David A. Garcia
Keyword(s):  
Atrial Fibrillation ◽  
Newly Diagnosed ◽  
Antithrombotic Drugs ◽  
Number Of Patients ◽  
Disproportionate Number ◽  
Randomised Controlled ◽  
Risk For Bleeding ◽  
Onset Atrial Fibrillation ◽  
Anticoagulant Medication ◽  
New Onset

SummaryAtrial fibrillation is a common condition that increases the risk of stroke in many patients. Although warfarin has been shown to reduce the risk of stroke, many patients who might benefit from anticoagulation do not receive this therapy. Fear of bleeding is the most often cited reason. Several new anticoagulant medications are being studied to determine their efficacy and safety relative to warfarin. Unlike earlier trials that established the superiority of warfarin over placebo, recent trials in atrial fibrillation have enrolled a disproportionate number of patients already taking warfarin. This review suggests that the risk of both haemorrhage and stroke are highest when atrial fibrillation is newly diagnosed and during the initiation of anticoagulant medication. Randomised controlled trials designed to evaluate the safety and efficacy of new anti-thrombotic agents should include substantial numbers of patients without prior exposure to anticoagulation since these individuals are at the highest risk for bleeding and thromboembolism.

scholarly journals New-onset atrial fibrillation is associated with 28-day mortality among patients with sepsis

2019 ◽  
Vol 2 (3) ◽  
pp. 31
Author(s):  
Finn Erland Nielsen
Keyword(s):  
Atrial Fibrillation ◽  
Adverse Outcomes ◽  
Registration System ◽  
Suspected Infection ◽  
Civil Registration ◽  
Survival Status ◽  
Poor Outcomes ◽  
Definition Of ◽  
Onset Atrial Fibrillation ◽  
New Onset

Background: New-onset atrial fibrillation (NO-AF) has been associated with adverse outcomes in sepsis. The definition of sepsis is based on organ dysfunction by use of the Sequential Organ Failure Assessment (SOFA) score. However, adult patients with suspected infection can be identified as being more likely to have poor outcomes typical of sepsis if they have at least two qSOFA criteria. We have analyzed the occurrence of NO-AF on admission and 28-day mortality among infected patients with two or more qSOFA criteria on admission. Methods: A prospective cohort study of infected patients aged 18 years or older admitted to the emergency department (ED) of Slagelse Hospital during 01.10.2017 – 31.03.2018 (171 days). The population in the area was 198.000. All patients with suspected or documented infection on arrival, and treated with antibiotics, were included. NO-AF was defined as episodes of atrial fibrillation (AF) within 4 hours from admission documented on a 12-lead electrocardiogram and without a history of prior AF. We used a logistic regression analysis to adjust for the potential confounding of the association between NO-AF and 28-day mortality. Survival status was obtained from the Danish Civil Registration System. Results: A total of 2.168 infected patients with median age of 73.1 years were included, and 181 (8.3%; 95% CI 4.7-13.3) fulfilled at least two qSOFA criteria on admission. The incidence of sepsis based on qSOFA criteria was estimated to 194/100,000. A total of 15 (8.3%, 95% CI 4.7-13.3) qSOFA patients developed NO-AF. The 28-day mortality among all qSOFA patients was 17.1% (95% CI 11.9-23.4), 40.0% (95 % 16.3-67.7) among patients with NO-AF and 15.1% (95% CI 10.0-21.4) among patients without NO-AF). Unadjusted odds ratio for 28-day mortality among NO-AF patients was 3.8 (95% CI 1.2-11.50) and 4.6 (95% CI 1.4-15.3) after adjustment for several potential confounders. Conclusion: New-onset atrial fibrillation is independently associated with 28-day mortality among patients with qSOFA defined sepsis.

scholarly journals A study on outcome of malaria and acute gastroenteritis induced acute kidney injury requiring hemodialysis

2018 ◽  
Vol 5 (3) ◽  
pp. 681
Author(s):  
Swarna Gupta ◽  
Punit Gupta ◽  
Vishal Jain
Keyword(s):  
Acute Kidney Injury ◽  
Peritoneal Dialysis ◽  
Kidney Function ◽  
Acute Gastroenteritis ◽  
Univariate Analysis ◽  
Disease Onset ◽  
Kidney Injury ◽  
Co2 Removal ◽  
Waste Products ◽  
Number Of Patients

Background: Acute kidney injury previously known as acute renal failure, is characterized by the sudden impairment of kidney function resulting in the retention of nitrogenous and other waste products normally cleared by the kidneys.   Acute Kidney Injury is usually manifested as multiorgan failure syndrome and extracorporeal support may also target fluid overload and heart failure, extracorporeal CO2 removal for combined kidney and lung support, albumin dialysis for liver support. Haemodialysis is more effective than peritoneal dialysis for management of Acute Kidney injury as Peritoneal dialysis is associated with clearance limitation and difficulties with fluid removal and is thus rarely used in adults in developed countries.Methods: The study was conducted in the Department of Medicine, Pt. J.N.M. Medical College and Dr. B.R.A.M. Hospital, Raipur (CG), India, from 2010 to 2012. All patients of both the sexes who were diagnosed as a case of Acute Kidney Injury due to Acute Gastroenteritis and Malaria and who were advised for Hemodialysis were included in the study. In our study, 32 patients of Acute Kidney Injury were included. The criteria used for AKI in the study was RIFLE criteria. Hemodialysis was done in all the cases. Quantitative variables are reported as means±SD and qualitative variables as percentage. Factor(s) determining outcome of AKI were tested by univariate analysis using “fisher’s exact test”. All variables with a P value <0.05 in the univariate analysis were defined statistically significant.Results: Out of 32 patients of Acute Kidney Injury in our study, 50% (n=16) were of Malaria associated AKI cases and other 50% (n=16) patients were of Acute Gastroenteritis associated AKI in which 87.5% males,12.5% Females were of Malaria and 75% male,25% Female were in AGE associated AKI. Maximum number of patients presented with features of AKI within first 3days of disease onset i.e. 56.25% (n=9) of malaria patients and 68.75% (n=11) of AGE patients. Mortality due to MOD was more common in Malaria patients as compared to AGE patients. AGE associated AKI patients had different level of deranged SOFA score.Conclusions: Acute kidney injury due to acute gastroenteritis differs from other causes of AKI by frequent occurrence of hypokalemia. Early diagnosis and prompt management can restore the kidney function.

scholarly journals CHA2DS2VASc score and adverse outcomes in middle-aged individuals without atrial fibrillation

2019 ◽  
Vol 26 (18) ◽  
pp. 1987-1997 ◽  
Author(s):  
Giulia Renda ◽  
Fabrizio Ricci ◽  
Giuseppe Patti ◽  
Nay Aung ◽  
Steffen E Petersen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischaemic Stroke ◽  
Cumulative Incidence ◽  
Adverse Outcomes ◽  
Annual Incidence ◽  
Middle Aged ◽  
Cox Regression Analysis ◽  
Coronary Events ◽  
Onset Atrial Fibrillation ◽  
New Onset

Aims The CHA2DS2VASc score is used to evaluate the risk of thromboembolic events in patients with non-valvular atrial fibrillation. We assessed the prognostic yield of CHA2DS2VASc for new-onset atrial fibrillation, cardiovascular morbidity and mortality in a non-atrial fibrillation population. Methods We analysed a population-based cohort of 22,179 middle-aged individuals with ( n = 3542) and without ( n = 18,367) a history of atrial fibrillation; we grouped the population into five CHA2DS2VASc strata (0–1–2–3–≥4), and compared the risk of major adverse cerebro-cardiovascular events and mortality. Furthermore, we analysed the annual incidence of atrial fibrillation across different CHA2DS2VASc strata. Results Over a median follow-up of 15 years, 1572 patients (6.9%) had ischaemic strokes, 2162 (9.5%) coronary events and 5899 (26%) died. The cumulative incidence of ischaemic stroke in CHA2DS2VASc ≥ 4 subjects without atrial fibrillation was similar to patients with atrial fibrillation and CHA2DS2VASc 2, with a 10-year crude incidence rate of 0.91 (95% confidence interval (CI) 0.68–1.19) and 1.13 (95% CI 0.93–1.36) ischaemic strokes per 100 patient-years, respectively. CHA2DS2VASc in a non-atrial fibrillation population showed higher predictive accuracy for ischaemic stroke compared with an atrial fibrillation population (area under the curve 0.60 vs. 0.56; P = 0.001). In multivariable Cox regression analysis, CHA2DS2VASc ≥ 2 was an independent predictor of all-cause death (adjusted hazard ratio (aHR) 2.58; 95% CI 2.42–2.76), cardiovascular death (aHR 3.40; 95% CI 2.98–3.89), ischaemic stroke (aHR 2.20; 95% CI 1.92–2.53) and coronary events (aHR 1.83; 95% CI 1.63–2.04). The cumulative incidence of atrial fibrillation was greater with increasing CHA2DS2VASc strata, with an absolute annual incidence of more than 2% per year if CHA2DS2VASc ≥ 4. Conclusion The CHA2DS2VASc score is a sensitive tool for predicting new-onset atrial fibrillation and adverse outcomes in subjects both with and without atrial fibrillation.

scholarly journals General Anesthesia Increased the Risk of Atrial Fibrillation and Acute Kidney Injury in Transcatheter Aortic Valve Replacement

2021 ◽  
Vol 24 (1) ◽  
pp. E082-E100
Author(s):  
Ying Liang ◽  
Wei Wang ◽  
Xu Wang ◽  
Mingzheng Liu ◽  
Feilong Hei ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Odds Ratio ◽  
Transcatheter Aortic Valve Replacement ◽  
Kidney Injury ◽  
Transcatheter Aortic Valve ◽  
New Onset

Purpose: To examine key impacts of anesthesia on new-onset atrial fibrillation (AF) and acute kidney injury (AKI) in transcatheter aortic valve replacement (TAVR). Methods: All consecutive patients who underwent transfemoral, transapical, and transaortic TAVR in Fuwai Hospital from 2012 to 2018 were retrospectively analyzed and dichotomized into 2 groups: TAVR under conscious sedation (CS) and under general anesthesia (GA). The primary endpoint was a composite of all-cause mortality, stroke, AF, permanent pacemaker implantation, myocardial infarction, heart failure, high-grade atrioventricular block, and AKI at 1 year. Binary logistic regression and adjusted multilevel logistic regression were performed to analyze the predictors of AF and AKI. Results: A total of 107 patients were under CS and 66 patients under GA. No significant difference was observed in the composite endpoint (51.5% vs. 41.2%, GA vs. CS, P = .182) and ≥ mild paravalvular leakage (36.4% vs. 31.4%, GA vs. CS, P = .589) at 1 year. However, the GA group had a significantly higher rate of intensive care unit (ICU) admission (84.8% vs. 6.5%, P < .001), AKI (28.8% vs. 14.0%, P = .018), new-onset AF (15.2% vs. 5.5% at 1 year, P = .036). Multivariable analysis revealed GA to be the significant predictor of new-onset AF (odds ratio 3.237, 95% confidence interval 1.059 to 9.894, P = .039) and AKI (odds ratio 2.517, 95% confidence interval 1.013 to 6.250, P = .047). Conclusion: GA was associated with higher rates of ICU admission, postoperative AKI, and new-onset AF. The results may provide new evidence that CS challenges universal GA.

Incidence of new-onset atrial fibrillation after cavotricuspid isthmus ablation for isolated typical atrial flutter: a systematic review and meta-analysis

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
A Griffin ◽  
A Thiyagarajah ◽  
M Middeldorp ◽  
D Lau ◽  
P Sanders
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Flutter ◽  
Cavotricuspid Isthmus ◽  
Kaplan Meier ◽  
Typical Atrial Flutter ◽  
Number Of Patients ◽  
Implantable Loop Recorders ◽  
Drug Free ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract Funding Acknowledgements Type of funding sources: None. Background There is a lack of consensus guidelines regarding the continuation of anticoagulant therapy following cavotricuspid isthmus (CTI) ablation for typical atrial flutter.  This is despite a significant number of patients developing new-onset atrial fibrillation (AF) following the procedure.  Furthermore, a summary of Kaplan-Meier estimates for drug-free, arrhythmia-free survival has never been reported. Purpose  To estimate the incidence of drug-free, new-onset AF stratified by rhythm monitoring strategy in patients undergoing  CTI ablation for isolated typical atrial flutter. Methods PubMed, Embase and MEDLINE databases were searched to identify relevant studies. Only studies where anti-arrhythmic drugs were discontinued post-ablation and that accounted for patient censoring by reporting results in the form of time to event data were included.  Data was extracted from published Kaplan-Meier curves using a digitizing software and confidence intervals for the survivor function were estimated based on the number at risk at the time point of interest. Results were pooled in a random effects model using the DerSimonian-Laird estimator. Results  Thirteen relevant studies incorporating 1712 patients (79 % male, mean age 63.2 +/-11.2 years,  LVEF 55.2 +/-10.8%) were identified. The estimated  freedom from  new-onset atrial fibrillation was 89.7% (95% CI: 80.3-90.1%) at 1 year and 86.2% (95% CI: 78.4-94.0%) at 2 years in patients undergoing predominantly symptom –based monitoring, 74.6% (95%CI: 67.0-82.3%) at 1 year and 69.5% (95%CI: 63.5-75.6%) at 2 years  in patients undergoing regular clinic follow-up with periodic Holter monitoring and 51.4% (95% CI: 41.8-61.0%) at 1 year and 22.7% (95% CI: 8.7% - 36.6%) at 2 years in patients with implantable loop recorders. Conclusion  With the advent of implantable loop recorders, it is apparent that most patients with isolated atrial flutter manifest new-onset AF following CTI ablation and the merits of discontinuing anticoagulation must be carefully considered in this population.  Symptom-based monitoring likely severely underestimates the incidence of new-onset AF and may lead to adverse outcomes, particularly in patients with a high risk of stroke.

scholarly journals Acute Kidney Injury Following Methimazole Initiation: A Case Report

2018 ◽  
Vol 33 (1) ◽  
pp. 99-101 ◽  
Author(s):  
Abigail Shell ◽  
Joshua W. Sullivan
Keyword(s):  
Acute Kidney Injury ◽  
Nephrotic Syndrome ◽  
Laboratory Data ◽  
Kidney Injury ◽  
Thyroid Stimulating Hormone ◽  
Graves Disease ◽  
Antithyroid Treatment ◽  
Onset Atrial Fibrillation ◽  
Tsh Levels ◽  
New Onset

Objective: Nephritis has been rarely associated with methimazole, primarily in the development of nephrotic syndrome. We describe a case of acute kidney injury without evidence of nephrotic syndrome following methimazole initiation. Methods: We present the relevant history, laboratory data, and nuclear medicine data and review relevant documentation from the literature. Results: A 72-year-old male recently diagnosed with new-onset atrial fibrillation was found to have suppressed thyroid-stimulating hormone (TSH) levels; elevated free T3, T4, and thyroid-stimulating immunoglobulin (TSI) levels; and a nonnodular thyroid gland with normal iodine uptake. He was diagnosed with Graves’ disease and treated with propylthiouracil (PTU) for 5 years. When his poor compliance with PTU was impeding his antithyroid treatment, he was converted to methimazole. Within 1 month following methimazole initiation, his serum creatinine (SCr) had risen to 1.6× baseline in the absence of other contributing nephrotoxins. SCr returned to baseline within 2 weeks of methimazole discontinuation, and the patient was subsequently managed on PTU. Conclusion: Acute kidney injury with or without the presence of nephrotic syndrome may occur during treatment with methimazole. Renal function should be closely monitored after the initiation of methimazole to prevent progressive renal dysfunction.

Acute dental periapical abscess and new-onset atrial fibrillation: A nationwide, population-based cohort study

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
A Hassan ◽  
G Lip ◽  
A Bisson ◽  
J Herbert ◽  
A Bodin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
National Database ◽  
Increased Risk ◽  
Periapical Abscess ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract Funding Acknowledgements Type of funding sources: None. Background There are limited data on whether there is an association between hospitalisation with dental periapical abscess and new-onset atrial fibrillation (AF) which is independent of main cardiovascular risk factors. Purpose To investigate whether there is an association between hospitalisation with dental periapical abscess and new-onset AF. Methods A retrospective cohort study from a national database of patients hospitalised in 2013 (3.4 million patients) with at least five years of follow up, unless deceased. International Classification of Diseases (ICD) codes were used to compare the risk of developing new-onset AF for adults with and without dental periapical abscesses using univariate and multivariable analysis and hazard ratios (HR). Results In total, 4,693 patients classified as having dental periapical abscess, 435 (9.27%) developed AF, compared to 326,241 (10.69%) without dental periapical abscess over a mean follow-up of 4.8 ± 1.7 years.  Multivariable analysis indicated that dental periapical abscess acted as an independent predictor for new onset AF (p &lt; 0.01). Conclusions An increased risk of new onset AF was identified for individuals hospitalised with dental periapical abscess. Careful follow up of patients with severe, acute dental periapical infections are needed for incident AF, as well as investigations of possible mechanisms linking these conditions. Predictors of new-onset AF during FU Univariate analysis Multivariate analysis HR, 95%CI P HR, 95%CI P Age, years 1.077 (1.076-1.077) &lt;0.0001 1.076 (1.075-1.076) &lt;0.0001 Gender (male) 1.640 (1.629-1.651) &lt;0.0001 1.0498 (1.487-1.509) &lt;0.0001 Hypertension 2.849 (2.829-2.869) &lt;0.0001 1.114 (1.487-1.509) &lt;0.0001 Diabetes mellitus 1.951 (1.935-1.968) &lt;0.0001 1.106 (1.096-1.116) &lt;0.0001 Heart failure 3.893 (3.857-3.930) &lt;0.0001 1.434 (1.416-1.452) &lt;0.0001 Ischaemic stroke 2.289 (2.23902.340) &lt;0.0001 1.140 (1.114-1.165) &lt;0.0001 smoker 0.903 (0.891-0.917) &lt;0.0001 1.052 (1.036-1.069) &lt;0.0001 Liver disease 1.141 (1.119-1.164) &lt;0.0001 1.082 (1.059-1.105) &lt;0.0001 Previous myocardial infarction 2.128 (2.082-2.176) &lt;0.0001 0.903 (0.880-0.926) &lt;0.0001 Inflammatory disease 1.036 (1.020-1.052) &lt;0.0001 0.978 (0.964-0.994) 0.005 Cognitive impairment 2.368 (2.326-2.410) &lt;0.0001 0.821 (0.807-0.836) &lt;0.0001 Illicit drug use 0.288 (0.263-0.317) &lt;0.0001 0.940 (0.855-1032) 0.19 Dental periapical abscess 0.855 (0.778- 0.939) 0.001 1.107 (1.008-1.216) 0.03 At least 5 years of follow-up (mean follow-up 4.8 ± 1.7 years). Abstract Figure. Flow Chart of the study patients

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