March 26, 2026

1643: Risk Factors for New-Onset Atrial Fibrillation in Critically Ill Septic Patients

Key Result

Age, BMI, acute kidney injury (RR=2.4), and mechanical ventilation (RR=1.91) independently predicted new-onset atrial fibrillation in critically ill patients with sepsis.

Key Points

This study aims to identify specific risk factors for new-onset atrial fibrillation (NOAF) in critically ill septic patients.
Single-center, retrospective study design
Involved adult patients with sepsis in ICU
Collected data on demographics, medical history, organ dysfunction
Used univariate and multivariable modified Poisson regression methods
199 patients included: 56 with NOAF, 143 without (AAF)
NOAF patients had higher BMI (31.2 vs 25.7) and heart rate (141 vs 89 bpm)
NOAF linked to longer ICU stays (7 vs 3 days) and higher inpatient mortality (41.1% vs 15.4%)
Key risk factors included age, BMI, acute kidney injury, and mechanical ventilation

Structured PICO

What are the risk factors for new-onset atrial fibrillation in critically ill septic patients?

Population

199 adult patients with sepsis admitted to the medical or surgical intensive care unit (ICU) between September 2019-2024.

Comparator

Patients who did not develop new-onset atrial fibrillation (absence of AF [AAF], n=143)

Outcome

Risk factors for new-onset atrial fibrillation (NOAF) developmenthard clinical

Age, BMI, acute kidney injury, and mechanical ventilation are independent risk factors for new-onset atrial fibrillation in critically ill septic patients, a complication associated with increased ICU stay and mortality.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Introduction: New-onset atrial fibrillation (NOAF) in critically ill patients is associated with worse clinical outcomes, including extended hospital stays and mortality. While NOAF risk factors are well characterized in the outpatient setting, they remain incompletely understood in the critically ill. The purpose of this study is to identify risk factors for NOAF development in the critically ill patients with sepsis. Methods: This single-center, retrospective study included adult patients with sepsis admitted to the medical or surgical intensive care unit (ICU) between September 2019-2024. Patients were classified into two groups: those who developed NOAF and those that did not absence of AF (AAF). Data collected included: demographics, medical history, degree of shock, and organ dysfunction. Secondary outcomes were time to first AF episode, ICU length of stay, and inpatient mortality. Univariate methods were used to identify potential risk factors, and a multivariable modified Poisson regression model was subsequently used to estimate and adjust risk for these factors. Results: There were 199 patients included: 56 NOAF and 143 AAF patients. NOAF patients had a higher body mass index (BMI), (31.2 vs 25.7, p< 0.001) and median norepinephrine equivalents (0.2 vs 0.12, p=0.32) at AF onset when compared to 48 hours post ICU admission in the AAF group. The median time to AF onset was 19.5 hours in the NOAF group. NOAF patients had a higher heart rate (141 vs 89 bpm, p< 0.001), acute kidney injury (71.4 vs 34.2%, p< 0.001), renal replacement therapy (26.7 vs 7.7%, p< 0.001), and mechanical ventilation (46.4 vs 23.8%, p=0.003). NOAF was associated with a longer ICU stay (7 vs 3 days, p< 0.001) and higher incidence of inpatient mortality (41.1 vs 15.4%, p< 0.001). The adjusted multivariable logistic regression found that age relative risk (RR)=1.04, p=0.0007), BMI (RR=1.04, p=0.0011), AKI (RR=2.4, p=0.0035), and mechanical ventilation (RR=1.91, p=0.017) remained strongly associated with development of NOAF in critically ill septic patients. Conclusions: Age, BMI, acute kidney injury, and need for mechanical ventilation were found to be risk factors for NOAF development in critically ill septic patients even after adjusting for each other. Further multi-center prospective studies are needed.

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