Atrial fibrillation epidemiology and impact on clinical outcomes in non-Hodgkin lymphoma patients hospitalized with sepsis: Evidence from nationwide data.

Abstract

e19048 Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is frequently complicated by sepsis. There is an association between AF and hematologic malignancies. Non-Hodgkin lymphoma (NHL) patients are prone to infections, and AF is common in this patient population. Despite this, limited data exist on the specific impact of AF on NHL patients hospitalized with sepsis. This study aims to explore how AF affects outcomes in this patient population, addressing a critical gap in knowledge. Methods: Patients diagnosed with NHL and hospitalized with sepsis between 2019 and 2021 were identified using ICD-10 codes from the National Inpatient Sample (NIS). Patients were stratified by the presence or absence of AF. Sociodemographic variables, comorbidities, and clinical outcomes were analyzed. The primary outcome was all-cause mortality, while secondary outcomes included complications, treatments, length of stay (LOS), and hospitalization costs. Multivariate regression models were utilized to assess associations, with statistical significance defined as p < 0.05 and adjusted odds ratios (aORs) or adjusted incidence rate ratios (aIRRs) reported with 95% confidence intervals (CI). Results: Among 67,064 NHL patients hospitalized with sepsis, 16,774 (25.01%) had AF. Patients with AF were older (mean age 75.52 years vs. 66.93 years, p < 0.001), predominantly male (63.8% vs. 36.2%, p < 0.001), identified as White (72.49%, p < 0.001), insured by Medicare (81.68%, p < 0.001), located in the southern United States (34.07%, p = 0.0004), and had a Charlson Comorbidity Index (CCI> 2: 86.53% vs. 74.72%, p < 0.001). AF patients had higher odds of all-cause mortality (aOR 1.53, 95% CI 1.37–1.72) and complications, including ventricular tachyarrhythmia (aOR 1.91, 95% CI 1.36–2.67), acute heart failure (aOR 2.11, 95% CI 1.82–2.46), respiratory failure (aOR 1.41, 95% CI 1.30–1.54), septic shock (aOR 1.65, 95% CI 1.49–1.82), metabolic encephalopathy (aOR 1.19, 95% CI 1.07–1.33), disseminated intravascular coagulation (aOR 1.44, 95% CI 1.01–2.05), acute kidney injury (aOR 1.34, 95% CI 1.23–1.47), and acute hepatic failure (aOR 1.41, 95% CI 1.09–1.81). Invasive interventions, such as renal replacement therapy (aOR 1.56, 95% CI 1.26–1.93), mechanical ventilation (aOR 1.46, 95% CI 1.25–1.70), and vasopressors (aOR 1.54, 95% CI 1.23–1.88), were more frequently required. AF was associated with higher costs ($120,230 vs. $115,924, aIRR 1.21, 95% CI 1.14–1.28) and LOS (8.83 vs. 8.33 days, aIRR 1.16, 95% CI 1.11–1.21). No differences were observed in rates of venous thromboembolism, gastrointestinal hemorrhage, acute ischemic stroke or acute hemorrhagic stroke. Conclusions: AF markedly worsens outcomes in NHL patients hospitalized with sepsis, as evidenced by higher mortality, increased complications, and greater healthcare resource utilization. These findings underscore the critical need for tailored management strategies aimed at improving outcomes in this vulnerable patient population.