Predicting stroke risk after sepsis hospitalization with new-onset atrial fibrillation

Laura C Myers; Ithan D Peltan; Khanh K Thai; Patricia Kipnis; Manisha Desai; Ycar Devis; Heather Clancy; Yun W Lu; Samuel M Brown; Alan S Go; Romain S Neugebauer; Vincent X Liu; Allan J Walkey

doi:10.1002/jhm.13343

Predicting stroke risk after sepsis hospitalization with new-onset atrial fibrillation

J Hosp Med. 2024 Apr 9. doi: 10.1002/jhm.13343. Online ahead of print.

Authors

Laura C Myers^{1

2}, Ithan D Peltan^{3

4}, Khanh K Thai^{1

2}, Patricia Kipnis^{1

2}, Manisha Desai⁵, Ycar Devis⁶, Heather Clancy^{1

2}, Yun W Lu^{1

2}, Samuel M Brown^{3

4}, Alan S Go^{1

2

7

8

9}, Romain S Neugebauer^{1

2}, Vincent X Liu^{1

2}, Allan J Walkey⁶

Affiliations

¹ The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, California, USA.
² Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
³ Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, Utah, USA.
⁴ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.
⁵ Biomedical Informatics Department, Stanford University, Palo Alto, California, USA.
⁶ Section of Pulmonary, Critical Care, Allergy, Sleep Medicine, Department of Medicine, The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts, USA.
⁷ Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA.
⁸ Department of Epidemiology and Biostatistics and Department of Medicine, University of California, San Francisco, San Francisco, California, USA.
⁹ Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA.

PMID: 38594918
DOI: 10.1002/jhm.13343

Abstract

Background: New-onset atrial fibrillation (AF) during sepsis is common, but models designed to stratify stroke risk excluded patients with secondary AF. We assessed the predictive validity of CHA₂DS₂VASc scores among patients with new-onset AF during sepsis and developed a novel stroke prediction model incorporating presepsis and intrasepsis characteristics.

Methods: We included patients ≥40 years old who survived hospitalizations with sepsis and new-onset AF across 21 Kaiser Permanente Northern California hospitals from January 1, 2011 to September 30, 2017. We calculated the area under the receiver operating curve (AUC) for CHA₂DS₂VASc scores to predict stroke or transient ischemic attack (TIA) within 1 year after a hospitalization with new-onset AF during sepsis using Fine-Gray models with death as competing risk. We similarly derived and validated a novel model using presepsis and intrasepsis characteristics associated with 1-year stroke/TIA risk.

Results: Among 82,748 adults hospitalized with sepsis, 3992 with new-onset AF (median age: 80 years, median CHA₂DS₂VASc of 4) survived to discharge, among whom 70 (2.1%) experienced stroke or TIA outcome and 1393 (41.0%) died within 1 year of sepsis. The CHA₂DS₂VASc score was not predictive of stroke risk after sepsis (AUC: 0.50, 95% confidence interval [CI]: 0.48-0.52). A newly derived model among 2555 (64%) patients in the derivation set and 1437 (36%) in the validation set included 13 variables and produced an AUC of 0.61 (0.49-0.73) in derivation and 0.54 (0.43-0.65) in validation.

Conclusion: Current models do not accurately stratify risk of stroke following new-onset AF secondary to sepsis. New tools are required to guide anticoagulation decisions following new-onset AF in sepsis.

Abstract

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