Analysis Of Clinical Risk Factors Of New-onset Atrial Fibrillation In Sepsis And Establishment Of Prediction Model

Background and Objective: New-onset atrial fibrillation in sepsis can lead to hemodynamic instability,which is one of the factors reflecting the severity of the disease and increases the risk of adverse complications and death.At present,there are reports on the incidence of new-onset atrial fibrillation in sepsis at home and abroad,but there are few studies on the risk factors of new-onset atrial fibrillation in sepsis.This paper aims to comprehensively analyze the risk factors of new-onset atrial fibrillation in sepsis.The purpose is to select independent relevant influencing factors,provide theoretical basis for the prevention and early identification,early intervention and treatment of new-onset atrial fibrillation in sepsis,and provide new possible ideas for reducing the occurrence of poor prognosis in patients with sepsis and improving the survival rate of patients.Methods: A case-control study was conducted on 74 patients(as the observation group)and 157 patients(as the control group)with new-onset atrial fibrillation diagnosed as sepsis treated in the Department of Critical Care Medicine,Affiliated Hospital of Chengde Medical College from January 2020 to December 2022.Using single factor analysis,logistic regression analysis,the receiver-operating characteristic curve(ROC)and combined forecast cutoff value and area under the ROC curve(AUC),select sepsis patients complicated with new risk factors for atrial fibrillation,build sepsis patients complicated with new af risk prediction model.Results: Sepsis new atrial fibrillation group with sepsis new af between age groups(Z = 3.243,P = 0.001),APACHE Ⅱ score(Z = 3.999,P =0.001),the SOFA score(Z = 7.653,P < 0.001),vascular active drug dose(Z= 9.23,P < 0.001),platelet count(Z = 1.981,P = 0.048),prothrombin time(Z = 2.120,P = 0.034),c-reactive protein(Z = 4.624,P < 0.001),brain natriuretic peptide(Z = 2.613,P = 0.009),troponin I(Z = 2.417,P = 0.016),blood lactic acid(Z = 2.285,P = 0.022)between group differences were statistically significant(P < 0.05).Convert numeric variable assignment to classification variables,multiple factors logistics regression analysis results suggest older age(> 65.0)(OR: 3.198,P = 0.039),high SOFA score(> 8)(OR: 51.287,P < 0.001),high-dose asoactie drugs(ug/kg * 0.3 min min)～ 2ug/kg *(see small dose group(0 ～ 0.3 ug/kg * min))(OR: 40.925,P <0.001),large dose of vascular active drugs(> 2.0ug/kg*min)(see small dose group(0 ～ 0.3ug/kg * min))(OR: 128.501,P < 0.001),high c-reactive protein(> 270 mg/L)(OR: 16.488,P < 0.001)and high lactic acid(> 2.49umol/L)(OR: 36.679,P = 0.003)is new sepsis patients independent risk factors for atrial fibrillation(P < 0.05).Age,SOFA score,c-reactive protein,lactic acid,vascular active drug dosage,and age SOFA score,age,c-reactive protein,age,lactic acid,SOFA a grade C reactive protein,SOFA SOFA lactic acid,lactic acid,c-reactive protein,age grading of c-reactive protein,age c-reactive protein lactic acid,lactic acid,age,SOFA SOFA score c-reactive protein grade lactic acid,age,SOFA c-reactive protein C reactive protein lactic acid doses joint models predict ROC AUC new atrial fibrillation in sepsis patients were 0.626,0.830,0.723,0.762,0.896,0.855,0.755,0.769,0.892,0.846,0.804,0.903,0.872,0.825,0.893,0.908,0.936.Age SOFA score vascular active drug dose c-reactive protein lactic acid five indicators combined AUC/single index and index of AUC compared to other model,in addition to compared with vascular active drug using single index model there was no statistically significant difference(P > 0.05),the ability to predict significantly greater than the rest of the single,double,three,four predicted results(P < 0.05).Conclusions: 1.Sepsis new onset atrial fibrillation(NOAF)is a complication of sepsis,in this study,74 patients with sepsis new onset atrial fibrillation,accounting for 32.0 % of the total sepsis patients.The heart rate increased from 113(93-132)beats / min to 132(119.5-141.5)beats / min(P < 0.001),and there was no significant difference in mean arterial pressure(P = 0.676).2.There was no significant difference in the history of atrial fibrillation between the sepsis new-onset atrial fibrillation group and the sepsis non-new-onset atrial fibrillation group(P > 0.05).3.Build logistics regression analysis,multiple factors prompt elderly(> 65years)(OR: 3.198,P = 0.039),high c-reactive protein(> 270 mg/L)(OR:16.488,P < 0.001),high lactic acid(> 2.49 umol/L)(OR: 36.679,P = 0.003),vascular active drug doses(0.3 ～ 2umol/L,>2umol/L)(OR: 40.925,P <0.001),(OR: 128.501,P < 0.001),high SOFA score(> 8)(OR: 51.287,P <0.001)as a new hair sepsis independent factors of atrial fibrillation for interpretation of sepsis new hair,the mechanism of atrial fibrillation for building function model forecasting the occurrence of sepsis new atrial fibrillation.4.The receiver operating characteristic curve was constructed to indicate age(> 65 years)(AUC = 0.626,sensitivity = 66.25%,specificity = 55.63%,95%confidence interval: 0.560-0.688,P = 0.001);SOFA score(> 8 points)(AUC= 0.830,sensitivity = 100%,specificity = 60.93%,95% confidence interval:0.775 to 0.876,P < 0.0001);C-reactive protein(> 268.86mg/L)(AUC =0.723,sensitivity = 51.25%,specificity = 87.42%,95% confidence interval:0.660-0.779,P < 0.0001);Lactate(> 2.48 mmol/L)(AUC = 0.762,sensitivity = 98.75%,specificity = 43.05%,95% confidence interval: 0.702 ～0.815,P < 0.0001);Vasoactive agents(> 0.45ug/kg*min)(AUC = 0.896,sensitivity = 89.87%,specificity = 85.33%,95% confidence interval: 0.849 to 0.932,P < 0.0001).It was better than other single index,double index,three index and four index prediction models except vasoactive drug dose(P< 0.05).5.The 28-day mortality of patients with new-onset atrial fibrillation in sepsis(46.3 %)was higher than that in sepsis non-new-onset atrial fibrillation group(31.1 %)(P < 0.05).