FC 106HIGHER MAGNESIUM DIALYSATE CONCENTRATION SIGNIFICANTLY IMPROVE SURVIVAL AND CEREBRAL OUTCOME IN HD-PATIENTS WITH ATRIAL FIBRILLATION: LONG-TERM STUDY ON GERMAN NETWORK DATA

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Karl August Brensing ◽  
Anna Ochsmann ◽  
Heyder Omran ◽  
Gerhard Lonnemann ◽  
Helmut Reichel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
High Risk ◽  
Adverse Events ◽  
Serum Albumin ◽  
Median Survival ◽  
Vascular Events ◽  
Long Term Outcome ◽  
Long Term Study

Abstract Background and Aims Hemodialysis (HD) patients with atrial fibrillation (AF) are at high risk for cardio-vascular events, severe bleeding and rapid vascular/valvular calcification. Thus, higher than low standard dialysate Mg (d-Mg) may improve outcome by less arrhythmic or calcification impact, but clinical data are missing. Our study evaluated applied d-Mg, risk-factors and antithrombotic therapies on long-term outcome in a large representative German HD-cohort. Method We used pseudonymized benchmarking data (2013-2018) of 16226 adult chronic HD patients (informed consent) from DNeV dialysis network. Diagnoses were coded by “International Classification of Diseases (ICD)” and drugs via “Anatomical Therapeutical Chemical (ATC)” codes. Risk scores (Carlson Comorbidity Index=CCI, CHA2DS2-VASc and HAS-BLED) were tested for de-novo outcome prediction. Results At baseline, 2752 (17%) HD-patients had coded AF. CHA2DS2-VASc (4.0/SD1.5) and HAS-BLED (3.2/0.9) estimated high risk for embolism/bleeding. Standard dialysate-Mg (sd-Mg; 0.5 mmol/L) was used by 1317 (48%), d-Mg 0.75 had 331 (12%), d-Mg >1.0 had 134 (5%) and 970 (35%) patients changed from 0.5 to 0.75 during the study period (change group). Median study time was 2.1 yrs (Range=R: 0.01–6 yrs.). Overall 6-yr mortality was high (63%; Kaplan Meier median survival of 2.9 yrs. Unchanged d-Mg levels were significantly (p<0.02) related to survival: Patients on sd-Mg had lower median survival (2.7 yrs.) than on 0.75 (3.1 yrs; p<0.05) or >1.0 (3.4 yrs; p=0.02). The change group had the same survival (3.1 yrs) as the 0.75 group (p<0.03 vs. 0.5). Cox-Regression (multivariate, sd-Mg=ref.) revealed d-Mg >1.0 (hazard ratio=HR 0.74), d-Mg 0.75 (HR 0.79), serum albumin (HR 0.93), age (HR 1.04) and CCI (HR 1.06) as independently related to mortality (p=0.002). Sd-Mg had higher (p<0.05) cerebral adverse events (5.2%) than 0.75 (1.8%) and >1.0 group (3.7%). Apart from dialysis-related heparin-supply four main approaches regarding anti-coagulation were identified: No therapy, VK-OAC, Heparin or only Aspirin/Clopidogrel (Asp/Clop): VK-OAC and Asp/Clop had same median survival (2.8 yrs) both better (p<0.001) than no therapy (1.3 yrs) or Heparin (1.6 yrs), but VK-OAC had higher bleeding rates (6.4%; p<0.001) than Asp/Clop (3.5%). Cerebral adverse events (3,8% in 6 yrs) were much lower than estimated and similar for all four regimes (R: 3.9-4.4%). Conclusion Use of higher d-Mg in HD-patients with AF significantly improved survival and cerebral outcome, is a feasible cost-effective approach and has more relative impact than well established survival risk-factors such as age, comorbidity (=CCI) and serum albumin. Our data warrant prospective trials comparing higher d-Mg levels with anti-thrombotic drugs and/or left atrial appendage occlusion for better evidence. So far, therapy of HD patients with AF should base on implementation of higher d-Mg, prefer Asp/Clop as best anti-thrombotic drugs and clearly avoid more harmful VK-OAC.

scholarly journals MO017ANTITHROMBOTIC THERAPIES AND CLINICAL OUTCOME OF ATRIAL FIBRILLATION IN ADULT HD-PATIENTS: LARGE LONG-TERM COHORT STUDY ON GERMAN NETWORK DATA

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Karl August Brensing ◽  
Anna Ochsmann ◽  
Heyder Omran ◽  
Gerhard Lonnemann ◽  
Helmut Reichel ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
High Risk ◽  
Adverse Events ◽  
Median Survival ◽  
Risk Scores ◽  
Active Therapy ◽  
Vascular Events ◽  
Long Term Outcome ◽  
Event Rates

Abstract Background and Aims ESRD (end stage renal disease) patients on hemodialysis (HD) with persistent atrial fibrillation (AF) are at high risk for cardio-vascular events, severe bleeding and rapid vascular/valvular calcification. In such patients standard vitamin-K based oral anticoagulation (VK-OAC) is debated, since prospective OAC studies are missing and smaller short-term register data showed conflicting results. Our study evaluated risk-factors, use of anticoagulants and clinical long-term outcome in a large representative German HD-cohort. Method After informed consent, we analysed pseudonymized benchmarking data (2013-2018) of 16226 adult chronic HD patients treated in a German outpatient dialysis network (Verband Deutsche Nierenzentren, DN) based on quarterly electronically transmitted data. Diagnoses were coded by “International Classification of Diseases (ICD)” and drugs via “Anatomical Therapeutical Chemical (ATC)” codes. Results At baseline in 2013, 2812 (17%) HD-patients had AF as coded diagnosis. AF-prevalence increased significantly (p<0.001) with age (< 65 yrs: 7%; 65-<75 yrs: 22% >75 yrs: 34%) without gender differences. Baseline CHA2DS2-Vasc (4.0/1.5) and HAS-Bled (3.2/0.9) risk scores indicated high risk for embolism and bleeding. Median observation time was 2.1 yrs (Range: 0–6 yrs.). Apart from dialysis-related heparin-supply four main approaches were applied: No active therapy, standard VK-OAC+/- aspirin/clopidogrel (VK-OAC+/-Asp/Clop), heparin-based therapy (Heparin+/-Asp/Clop) or only anti-thrombocyte drugs (Asp/Clop). Baseline risk scores were not related to any adverse events. Outcome data are shown in the Table: event rates were low (8.8%) and comparable for all anticoagulant therapies, especially for cerebral adverse events (3.8%, range 3.3-4.5%). Patients on any anti-thrombotic therapy had similar outcome rates as patients without anticoagulant therapy. The latter had fewer overall bleeding events (3.8% vs. 5.0%; NS). Finally, overall actual 6-yr mortality rates were high (55.8%; median survival 4.4 yrs) and significantly (p<0.001) lower for patients without anti-coagulant therapy (48.9%; median survival 6.0 yrs) than for patients on anti-coagulant therapy (59.5%; median survival 4.0 yrs) with highest mortality on VK-OAC based therapy (60.3%; p<0.001). Conclusion De-novo cerebral event-rates were rather low (<0.8%/yr) and similar for all anti-thrombotic therapies and even for patients with no active therapy, suggesting major beneficial impact of regular dialysis-related heparin-supply. Since actual 6-yr mortality was high and survival was significantly better in patients without anticoagulants than for VK-OAC or other active therapy, we need prospective studies comparing anticoagulants even with no drugs and/or new interventional approachs (i.e. left atrial appendage closure) to provide valid future guidelines.

scholarly journals Predictors for the Immediate and Long-Term Outcome of Avascular Surgical Procedure

2009 ◽  
Vol 98 (3) ◽  
pp. 164-168 ◽  
Author(s):  
J. Virkkunen ◽  
M. Venermo ◽  
J. Saarinen ◽  
J. Salenius
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
High Risk ◽  
Predictive Value ◽  
Surgical Procedure ◽  
Operative Mortality ◽  
Survival Rates ◽  
Term Outcome ◽  
Long Term Outcome

Background and Aims: The ability to predict post-operative mortality reliably will be of assistance in making decisions concerning the treatment of an individual patient. The aim of this study was to test the GAS score as a predictor of post-operative mortality in vascular surgical patients. Material and Methods: A total of 157 consecutive patients who underwent an elective vascular surgical procedure were included in the study. The Cox proportional hazards model was used in analyzing the importance of various preoperative risk factors for the postoperative outcome. ASA and GAS were tested in predicting the short and long-term outcome. On the basis of the GAS cut-off value 77, patients were selected into low-risk (GAS low: GAS < 77) and high-risk (GAS high: GAS > = 77) groups, and the examined risk factors were analyzed to determine which of them had predictive value for the prognosis. Results: None of the patients in the GAS low group died, and mortality in the GAS high group was 4.8% (p = 0.03) at 30 days' follow-up. The 12-month survival rates were 98.6% and 78.6% (p = 0.0001), respectively, with the respective 5-year survival rates of 76.7% and 44.0% (p = 0.0001). The only independent risk factor for 30-day mortality was the renal risk factor (OR 20.2). The combination of all three GAS variables(chronic renal failure, cardiac disease and cerebrovascular disease), excluding age, was associated with a 100% two-year mortality. Conclusions: Mortality is low for patients with GAS<77. For the high-risk patients (GAS> = 77), due to its low predictive value for death, GAS yields limited value in clinical practice. In cases of patients with all three risk factors (renal, cardiac and cerebrovascular), vascular surgery should be considered very carefully.

scholarly journals 253 Sepsis associated New Onset Atrial Fibrillation; Risk Factors and Long-term Outcome

2020 ◽  
Vol 29 ◽  
pp. S147
Author(s):  
V. Moosavi ◽  
M. Paymard ◽  
R. Ebrahimi ◽  
T. Harvey ◽  
N. Parkes ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Onset Atrial Fibrillation ◽  
New Onset

scholarly journals Exploring Mechanisms of Change in the Rehabilitation of High-Risk Offenders

2021 ◽  
Author(s):  
◽  
Julia A. Yesberg
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Outcome Evaluation ◽  
Mechanisms Of Change ◽  
Offender Rehabilitation ◽  
Treatment Change ◽  
Long Term Outcome ◽  
Dynamic Risk ◽  
Intermediate Outcomes

<p>The success or failure of many different types of treatment is often measured by one type of outcome. For example, treatment for substance abuse might be judged to have failed if a patient “goes on a bender” some time after completing the programme. The same is true for offender rehabilitation. Treatment success or failure is usually determined by whether or not an offender is reconvicted of a new offence in a specified follow-up period. We know from the literature that offender rehabilitation can have modest but significant effects on reducing recidivism. Yet we know little about what brings about these reductions (i.e., how the treatment worked). This thesis explores possible mechanisms of change in offender rehabilitation. I propose that although a reduction in recidivism is an important long-term outcome of treatment, there are a number of additional outcomes that have the potential to explain not only if but how treatment works and why it is unsuccessful in leading to a reduction in reoffending for some offenders.  Study 1 is a typical outcome evaluation of New Zealand’s rehabilitation programmes for high-risk male offenders: the High Risk Special Treatment Units (HRSTUs). I compared the recidivism rates of a sample of HRSTU completers with a comparison sample of high-risk offenders who had not completed the programme (a between-subjects design). I found that relative to the comparison group, treatment completers had significantly lower rates of four different indices of recidivism, varying in severity. The remainder of the thesis explored possible mechanisms of change within the HRSTU sample (a within-subjects design). Study 2 examined immediate outcomes of treatment, which I defined as within-treatment change on dynamic risk factors. I found that offenders made significant change on the Violence Risk Scale during treatment, but there was no significant relationship between treatment change and recidivism. Studies 3 and 4 examined intermediate outcomes of treatment, which I defined as barriers (risk factors) and facilitators (protective factors) that influence the process of offender re-entry. Study 3 validated an instrument designed to measure these factors: the Dynamic Risk Assessment for Offender Re-entry (DRAOR). I found that the tool had good convergent validity and reliably predicted recidivism above a static risk estimate. Study 4 used the newly validated DRAOR to test an explanation for the lack of a direct relationship between treatment change and recidivism. I tested whether treatment change had an indirect relationship with recidivism through its influence on the re-entry process. I found that treatment change was related to a number of re-entry outcomes; however, only two models could be tested for mediation because the re-entry outcomes themselves lacked predictive ability. Nevertheless, findings from Study 4 suggest the re-entry process is an area worthy of further investigation.  Taken together, the findings from this thesis highlight the importance of considering alternative treatment outcomes in addition to whether or not a programme leads to a reduction in long-term recidivism outcomes. Answering the question of how treatment works requires an exploration into possible mechanisms of change. This thesis was only a preliminary investigation into such mechanisms; however, the findings have both practical and theoretical implications for the way we conceptualise how treatment programmes work. Developing a greater understanding of mechanisms of change in offender rehabilitation has the potential to lead to the design and delivery of more effective programmes.</p>

scholarly journals Post-contrast acute kidney injury in a hospitalized population: short-, mid-, and long-term outcome and risk factors for adverse events

2020 ◽  
Vol 30 (6) ◽  
pp. 3516-3527
Author(s):  
Wei Cheng ◽  
Xi Wu ◽  
Qian Liu ◽  
Hong-Shen Wang ◽  
Ning-Ya Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Adverse Events ◽  
Kidney Injury ◽  
Term Outcome ◽  
Post Contrast ◽  
Long Term Outcome

scholarly journals 2MACE score predicts cardiovascular adverse events in real-world atrial fibrillation patients under rivaroxaban therapy. Data from EMIR study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Esteve Pastor ◽  
F Marin ◽  
M Anguita ◽  
M Sanmartin ◽  
C Rafols ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
High Risk ◽  
Adverse Events ◽  
Cardiovascular Mortality ◽  
Real World ◽  
Cardiovascular Events ◽  
Major Adverse Cardiovascular Events

Abstract Background Atrial Fibrillation (AF) patients have higher risk of major adverse cardiovascular events (MACEs). In 2015, the 2MACE score (2 points for metabolic syndrome and age ≥75, and 1 point for myocardial infarction [MI] or revascularization, congestive heart failure [ejection fraction ≤40%] and thromboembolism [stroke or transient ischemic attack]) was described to stratify cardiovascular risk and 2MACE≥3 was related with high risk of MACE in AF patients but a long-term validation in prospective patients under direct anticoagulants has not been performed yet. The aim of this study was to analyse the incidence of cardiovascular events and to validate the 2MACE score as predictor of MACEs. Methods EMIR study [acronym from 'Estudio observacional para la identificaciόn de los factores de riesgo asociados a eventos cardiovasculares Mayores en pacientes con fIbrilaciόn auricular no valvular tratados con un anticoagulante oral directo (Rivaroxaban)'] was an observational, multicenter, post-authorization and prospective study that involved AF patients under oral anticoagulation with rivaroxaban at least 6 months before enrolment. We analyzed baseline clinical characteristics and adverse events after 2.5 years of follow up: annual incidence of thromboembolic events, MACE (composite of nonfatal MI, coronary revascularization and cardiac death) and cardiovascular mortality were analyzed. Results We analyzed 1,433 patients (55.5% women, mean 74.2±9.7 years). 385 (26.9%) patients had 2MACE score ≥3 and of those high-risk patients, 42.1% had previous coronary disease, 12.5% had previous peripheral artery disease, 40.7% had diabetes mellitus, 39% heart failure and 50% had chronic kidney disease (GFR&lt;60 ml/min). After 2.5 (2.2–2.6) years of follow-up, we observed patients with 2MACE score ≥3 had higher rate of adverse events (Table), specially of higher rate of cardiovascular mortality and MACE. Patients with 2MACE score ≥3 had RR 4.09 (2.59–6.45; p&lt;0.001) for MACE. Indeed, patients with 2MACE score ≥3 had around 6-fold risk of cardiovascular death due heart failure than patients with 2MACE score &lt;3 (0.17%/year vs 1.09%/year; p=0.003). 2MACE score had suitable predictive performance for MACE (AUC 0.638 [(0.534–0.742); p=0.010). Conclusion In a Real-world AF patients under rivaroxaban therapy from EMIR registry, the 2MACE score is a good predictor of long-term cardiovascular events, MACE and major bleeding. A 2MACE score ≥3 categorize patients at “high-risk” with almost 4-fold risk of MACE in a long-term follow-up. FUNDunding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Bayer Hispania S.L. Table 1. Adverse events according to 2MACE

scholarly journals Exploring Mechanisms of Change in the Rehabilitation of High-Risk Offenders

2021 ◽  
Author(s):  
◽  
Julia A. Yesberg
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Outcome Evaluation ◽  
Mechanisms Of Change ◽  
Offender Rehabilitation ◽  
Treatment Change ◽  
Long Term Outcome ◽  
Dynamic Risk ◽  
Intermediate Outcomes

<p>The success or failure of many different types of treatment is often measured by one type of outcome. For example, treatment for substance abuse might be judged to have failed if a patient “goes on a bender” some time after completing the programme. The same is true for offender rehabilitation. Treatment success or failure is usually determined by whether or not an offender is reconvicted of a new offence in a specified follow-up period. We know from the literature that offender rehabilitation can have modest but significant effects on reducing recidivism. Yet we know little about what brings about these reductions (i.e., how the treatment worked). This thesis explores possible mechanisms of change in offender rehabilitation. I propose that although a reduction in recidivism is an important long-term outcome of treatment, there are a number of additional outcomes that have the potential to explain not only if but how treatment works and why it is unsuccessful in leading to a reduction in reoffending for some offenders.  Study 1 is a typical outcome evaluation of New Zealand’s rehabilitation programmes for high-risk male offenders: the High Risk Special Treatment Units (HRSTUs). I compared the recidivism rates of a sample of HRSTU completers with a comparison sample of high-risk offenders who had not completed the programme (a between-subjects design). I found that relative to the comparison group, treatment completers had significantly lower rates of four different indices of recidivism, varying in severity. The remainder of the thesis explored possible mechanisms of change within the HRSTU sample (a within-subjects design). Study 2 examined immediate outcomes of treatment, which I defined as within-treatment change on dynamic risk factors. I found that offenders made significant change on the Violence Risk Scale during treatment, but there was no significant relationship between treatment change and recidivism. Studies 3 and 4 examined intermediate outcomes of treatment, which I defined as barriers (risk factors) and facilitators (protective factors) that influence the process of offender re-entry. Study 3 validated an instrument designed to measure these factors: the Dynamic Risk Assessment for Offender Re-entry (DRAOR). I found that the tool had good convergent validity and reliably predicted recidivism above a static risk estimate. Study 4 used the newly validated DRAOR to test an explanation for the lack of a direct relationship between treatment change and recidivism. I tested whether treatment change had an indirect relationship with recidivism through its influence on the re-entry process. I found that treatment change was related to a number of re-entry outcomes; however, only two models could be tested for mediation because the re-entry outcomes themselves lacked predictive ability. Nevertheless, findings from Study 4 suggest the re-entry process is an area worthy of further investigation.  Taken together, the findings from this thesis highlight the importance of considering alternative treatment outcomes in addition to whether or not a programme leads to a reduction in long-term recidivism outcomes. Answering the question of how treatment works requires an exploration into possible mechanisms of change. This thesis was only a preliminary investigation into such mechanisms; however, the findings have both practical and theoretical implications for the way we conceptualise how treatment programmes work. Developing a greater understanding of mechanisms of change in offender rehabilitation has the potential to lead to the design and delivery of more effective programmes.</p>

Long-Term Outcome in Polycythemia Vera (PV): Final Analysis of a Randomized Trial Comparing Hydroxyurea (HU) to Pipobroman (Pi).

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1746-1746 ◽  
Author(s):  
Jean-Jacques Kiladjian ◽  
Sylvie Chevret ◽  
Christine Dosquet ◽  
Pierre Fenaux ◽  
Christine Chomienne ◽  
...  
Keyword(s):  
Median Survival ◽  
Cumulative Incidence ◽  
Randomized Clinical Trials ◽  
Final Analysis ◽  
Vascular Events ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Mortality And Morbidity

Abstract Background: Only 4 randomized clinical trials in PV have directly compared cytoreductive therapies (32P, busulfan, chlorambucil, HU, and Pi), all published after a median follow-up of 10 years or less. Thrombosis was the main cause of mortality and morbidity in all trials. Cumulative incidence of evolution to myelofibrosis (MF), and acute myeloid leukemia or myelodysplastic syndromes (AML/MDS) was about 8%, and 6%, respectively. In 1 of those trials, conducted between 1980 and 1996 by the French Polycythemia Study Group (FPSG) in 292 PV patients (pts) younger than 65 yrs, no difference between HU and Pi was found in terms of survival, risk of thrombosis, and AML/MDS/MF evolution at the time of first analysis with a median follow up of 7 years (Najean, Blood, 1997, 90:3370). Methods: We updated the results of the FPSG trial at the reference date of April 15, 2008, with a median follow-up of 16.3 years. After randomization in the trial (136 pts in the HU arm, 149 in the Pi arm), 94 (33%) pts had received only HU, 130 (46%) only Pi, and 61 (21%) both drugs (including 42 who had switched from HU to Pi, and 19 from Pi to HU) during the whole follow-up period (7 patients were excluded from the final analysis because of incomplete follow up data). To take into account treatment crossovers, statistical analysis was performed both in “intention to treat” (ITT) and according to the main treatment received (i.e. treatment effectively received). Results: Median survival was 20.3 years (95%CI: 16.4 – 25) in HU arm, and 15.4 years (95%CI: 13.4 – 17) in Pi arm (p=0.008). 95 pts have died, the 3 main causes of death being evolution to AML/MDS in 51 pts (54%), vascular events in 19 pts (20%), and solid tumor in 11 (12%) pts. The 51 cases of evolution to AML/MDS included 10 MDS, and 41 AML (including 5 preceded by an MDS phase). Cumulative incidence (CI) of AML/MDS at 10, 15, and 20 years in ITT analysis was 6.6%, 16.5%, and 24% in the HU arm, and 13%, 34%, and 52% in the Pi arm, respectively (p= 0.004). As the median duration of HU treatment (12 years) was significantly longer than that of Pi treatment (9.5 years, p=0.0002), we also performed the analyses according to the main treatment actually received by pts, which showed cumulative incidence of AML/MDS of 7%, 14%, and 22% with HU, and 12%, 37%, and 56% with Pi at 10, 15, and 20 years, respectively (p=0.008), confirming the results obtained in ITT analyses. Regarding MF, the CI at 10, 15 and 20 years was comparable in both arms in ITT analysis: 12.6%, 19%, and 27% in the HU arm, and 7.8%, 16%, and 27% in the Pi arm, respectively (p=0.7). However, a significantly higher incidence of MF was found in pts who had received HU as main treatment: 15%, 24%, and 32% at 10, 15, and 20 years, compared to 5%, 10%, and 21%, respectively, in patients who received mainly Pi (p=0.02). Conclusion: Although medium-term analysis of FPSG trial did not show differences between HU and Pi, current update after a median follow-up of 16.3 years finally showed that median survival was shorter, and incidence of AML/MDS higher in Pi treated pts. By contrast, risk of MF was higher in pts treated predominantly with HU. Of note, was the clearly higher than previously reported cumulative incidence of AML/MDS with HU. Evolution to AML/MDS represented by far the first cause of death in the long-term (54% versus 20% for vascular events). Those results suggest that Pi should not be used as first line therapy in PV patients, and that very long term may be required to draw conclusions regarding leukemic evolution in PV trials.

scholarly journals New-Onset Atrial Fibrillation is an Independent Predictor of Mortality in Patients With Candidemia

2021 ◽  
Author(s):  
Zengli Xiao ◽  
Anqi Du ◽  
Youzhong An
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Independent Predictor ◽  
Long Term Outcome ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract Background: Candidemia, or invasive candidiasis infection, is prevalent in critically ill patients and significantly contributes to the mortality and morbidity of such patients. New-onset atrial fibrillation (NOAF) also occurs frequently in critically ill patients. However, the association between NOAF and candidemia is still uncertain. This study aims to determine whether NOAF could increase the mortality rate of critically ill patients who have candidemia.Methods: We retrospectively identified NOAF in all patients who were admitted into a non-cardiac intensive care unit (ICU) and diagnosed as candidemia from January 2011 to March 2018. These patients were divided into 3 groups (NOAF, Prior AF, No AF). Clinical information and long-term outcome were collected and compared between three groups . Risk factors for these patients’ short-term and long-term mortality were also analyzed.Results: Ninety-two patients with candidemia were included from 2011 to 2018. Among these patients, 26 (28.3%) developed NOAF during their ICU hospitalization. Patients with NOAF had lower survival rate than those who never developed AF. The multivariate logistic regression analysis indicated that stroke, anemia, Sequential Organ Failure Assessment (SOFA) score and NOAF were independent risk factors for in-hospital mortality and NOAF was also an independent risk factor for 1 year mortality. Conclusions: There was a high incidence of NOAF in patients with candidemia. In this study, we found NOAF was an independent predictor of in-hospital mortality and 1 year mortality after hospital discharge for patients with candidemia.

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