Sepsis-induced coagulopathy is associated with new episodes of atrial fibrillation in patients admitted to critical care in sinus rhythm

Ortega-Martorell, Sandra ORCID: 0000-0001-9927-3209, Olier, Ivan, Johnston, Brian W ORCID: 0000-0003-1634-3297 and Welters, Ingeborg D ORCID: 0000-0001-8734-994X (2023) Sepsis-induced coagulopathy is associated with new episodes of atrial fibrillation in patients admitted to critical care in sinus rhythm. FRONTIERS IN MEDICINE, 10. 1230854-.

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Official URL: http://dx.doi.org/10.3389/fmed.2023.1230854

Abstract

<h4>Background</h4>Sepsis is a life-threatening disease commonly complicated by activation of coagulation and immune pathways. Sepsis-induced coagulopathy (<i>SIC</i>) is associated with micro- and macrothrombosis, but its relation to other cardiovascular complications remains less clear. In this study we explored associations between <i>SIC</i> and the occurrence of atrial fibrillation (AF) in patients admitted to the Intensive Care Unit (ICU) in sinus rhythm. We also aimed to identify predictive factors for the development of AF in patients with and without <i>SIC</i>.<h4>Methods</h4>Data were extracted from the publicly available AmsterdamUMCdb database. Patients with sepsis and documented sinus rhythm on admission to ICU were included. Patients were stratified into those who fulfilled the criteria for <i>SIC</i> and those who did not. Following univariate analysis, logistic regression models were developed to describe the association between routinely documented demographics and blood results and the development of at least one episode of AF. Machine learning methods (gradient boosting machines and random forest) were applied to define the predictive importance of factors contributing to the development of AF.<h4>Results</h4>Age was the strongest predictor for the development of AF in patients with and without <i>SIC</i>. Routine coagulation tests activated Partial Thromboplastin Time (aPTT) and International Normalized Ratio (INR) and C-reactive protein (CRP) as a marker of inflammation were also associated with AF occurrence in <i>SIC</i>-positive and <i>SIC</i>-negative patients. Cardiorespiratory parameters (oxygen requirements and heart rate) showed predictive potential.<h4>Conclusion</h4>Higher INR, elevated CRP, increased heart rate and more severe respiratory failure are risk factors for occurrence of AF in critical illness, suggesting an association between cardiac, respiratory and immune and coagulation pathways. However, age was the most dominant factor to predict the first episodes of AF in patients admitted in sinus rhythm with and without <i>SIC</i>.

Item Type:	Article
Uncontrolled Keywords:	atrial fibrillation, sepsis, machine learning, coagulopathy, database analysis, Sepsis-induced coagulopathy
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User:	Symplectic Admin
Date Deposited:	22 Sep 2023 10:16
Last Modified:	18 Oct 2023 03:22
DOI:	10.3389/fmed.2023.1230854
Open Access URL:	https://doi.org/10.3389/fmed.2023.1230854
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3172975