The impact of atrial fibrillation in patients with COPD during hospitalization

Figures & data

Table 1 Demographic characteristics and comorbidities in COPD patients with and without AF

	With AF (N=882)	Without AF (N=2,646)	P-value
Age (years), mean (±SD)	67.3 (±12.8)	67.0 (±12.6)	0.5836
Age stratification, n (%)			0.9860
<40	30 (3.4)	98 (3.7)
40–49	60 (6.8)	172 (6.5)
50–59	110 (12.5)	326 (12.3)
60–69	249 (28.1)	761 (28.8)
70	443 (50.2)	1,289 (48.7)
Gender, n (%)
Male	560 (63.5)	1,751 (66.2)	0.1465
Female	322 (36.5)	895 (33.8)
Urban living, n (%)			0.1568
Urban	582 (66.0)	1,814 (68.6)
Rural	300 (34.0)	832 (31.4)
Comorbidities, n (%)
Hypertension	602 (68.3)	1,225 (46.3)	<0.0001
Diabetes	201 (22.8)	437 (16.5)	<0.0001
Hyperlipidemia	172 (19.5)	389 (14.7)	0.0007
Cerebrovascular accident	223 (25.3)	446 (16.9)	<0.0001
Congestive heart failure	176 (20.0)	222 (8.4)	<0.0001
Cancer	100 (11.3)	256 (9.7)	0.1556
Infection, n (%)
At least one site	221 (25.1)	496 (18.7)	<0.0001
Respiratory	128 (14.5)	295 (11.1)	0.0077
Genitourinary	79 (8.9)	149 (5.6)	0.0005
Life-support measures, n (%)
Intensive care unit	83 (9.4)	153 (5.8)	0.0002
Vasopressor use	24 (2.7)	34 (1.3)	0.0037
Hemodialysis	9 (1.0)	9 (0.3)	0.0141
Mechanical ventilation	61 (6.9)	115 (4.3)	0.0024

Abbreviations: AF, atrial fibrillation; SD, standard deviation.

Table 2 Effects of AF on the risk of outcomes in patients with COPD

Variables	With AF* (N=882)	Without AF* (N=2,646)	Crude HR (95% CI)	P-value	Adjusted HR (95% CI)†	P-value
Primary outcome	392 (44.4)	973 (36.8)	1.356 (1.206–1.525)	<0.0001	1.169 (1.034–1.320)	0.0124
Secondary outcomes
Acute organ dysfunction	359 (40.1)	883 (33.4)	1.366 (1.208–1.545)	<0.0001	1.179 (1.037–1.339)	0.0116
Severe sepsis	181 (20.5)	500 (18.9)	1.174 (0.990–1.391)	0.0651	1.057 (0.886–1.262)	0.5350
Respiratory failure	240 (27.2)	592 (22.3)	1.323 (1.139–1.538)	0.0003	1.176 (1.006–1.374)	0.0421
Death	194 (22.0)	537 (20.3)	1.171 (0.994–1.380)	0.0597	1.034 (0.871–1.227)	0.7053

Notes:

* Values are expressed as n (%).

† Covariates include baseline factors (ie, age, gender, comorbidities, urban living, infection sites, and life-support measures).

Abbreviation: AF, atrial fibrillation.

Table 3 Acute organ dysfunction in COPD patients with and without AF stratified by diseases

Variables	With AF* (N=882)	Without AF* (N=2,646)	Adjusted HR (95% CI)†	P-value
Acute organ dysfunction	359 (40.1)	883 (33.4)	1.179 (1.037–1.339)	0.0116
Cardiovascular	159	387	1.150 (0.949–1.393)	0.1548
Respiratory	252	603	1.213 (1.041–1.414)	0.0132
Renal	94	221	1.116 (0.867–1.436)	0.3943
Hepatic	24	41	1.882 (1.113–3.181)	0.0183
Neurologic	28	94	0.828 (0.535–1.280)	0.3952
Hematologic	26	56	1.260 (0.772–2.055)	0.3551
Metabolic	15	32	1.225 (0.643–2.335)	0.5379

Notes:

* Values are expressed as n (%).

† Covariates include baseline factors (ie, age, gender, comorbidities, urban living, infection sites, and life-support measures).

Abbreviation: AF, atrial fibrillation.

Table 4 Adjusted HRs for factors associated with the risk of primary outcome and acute organ dysfunction in the follow-up period

Variable	Primary outcome		Acute organ dysfunction
	aHR (95% CI)a	P-value	aHR (95% CI)a	P-value
Non-atrial fibrillation	1		1	1
Atrial fibrillation	1.169 (1.034–1.320)	0.012	1.179 (1.037–1.339)	0.012
Age	1.067 (1.06–1.074)	<0.001	1.065 (1.059–1.072)	<0.001
Female	1		1
Male	1.333 (1.183–1.502)	<0.001	1.287 (1.136–1.457)	0.001
Rural	1		1
Urban	1.145 (1.021–1.284)	0.021	1.133 (1.005–1.277)	0.042
Comorbidity
Hypertension	1.113 (0.988–1.253)	0.078	1.184 (1.045–1.342)	0.008
Diabetes	1.279 (1.119–1.461)	<0.001	1.269 (1.104–1.459)	0.001
Hyperlipidemia	0.863 (0.734–1.013)	0.072	0.811 (0.683–0.963)	0.017
Cerebrovascular accident	1.340 (1.181–1.521)	<0.001	1.324 (1.159–1.511)	<0.001
Congestive heart failure	1.519 (1.294–1.784)	<0.001	1.485 (1.256–1.757)	<0.001
Cancer	1.092 (0.924–1.289)	0.301	1.052 (0.881–1.256)	0.577
Infection
At least one site	1.689 (1.373–2.078)	<0.001	1.704 (1.375–2.113)	<0.001
Respiratory	1.218 (0.978–1.516)	0.078	1.194 (0.952–1.499)	0.126
Genitourinary	1.273 (1.01–1.603)	0.041	1.246 (0.982–1.581)	0.070
Life-support measures
Intensive care	1.340 (0.998–1.799)	0.052	1.331 (0.976–1.815)	0.071
Vasopressor use	1.160 (0.789–1.705)	0.451	1.227 (0.826–1.821)	0.311
Hemodialysis	1.751 (0.899–3.411)	0.100	1.707 (0.847–3.441)	0.135
Mechanical ventilation	1.755 (1.237–2.491)	0.002	1.768 (1.228–2.5463)	0.002

Note:

a Covariates included baseline covariates (ie, age, gender, comorbidities, urbanization, infection sites, life-support measures).

Abbreviations: aHR, adjusted HR; CI, confidence interval.

Figure 1 Primary outcome in COPD patients with and without AF.

Abbreviation: AF, atrial fibrillation.

Table S1 Diagnostic codes for acute organ dysfunction

Organ dysfunction	Codes	Code description
Cardiovascular	458.0	Hypotension, postural
	458.8	Hypotension, specified type, not elsewhere classified
	458.9	Hypotension, arterial, constitutional
	785.5	Shock
	785.51	Shock, cardiogenic
	785.59	Shock, circulatory or septic
	796.3	Hypotension, transient
Respiratory	518.81	Acute respiratory failure
	518.82	Acute respiratory distress syndrome (ARDS)
	518.85	ARDS aftershock or trauma
	786.09	Respiratory insufficiency
	799.1	Respiratory arrest
	96.7 (96.71, 96.72)	Ventilator management
	96.04	Endotracheal intubation (emergency procedure)
	93.90	Continuous positive airway pressure
Renal	584.x	Acute renal failure
Hepatic	570	Acute hepatic failure or necrosis
	572.2	Hepatic encephalopathy
	573.3	Hepatitis (septic and not elsewhere classified)
	573.4	Hepatic infarction
Neurologic	293	Transient organic psychosis
	348.1	Anoxic brain injury
	348.3	Encephalopathy, acute
	780.01	Coma
	780.09	Altered consciousness, unspecified
	89.14	Electroencephalography
Hematologic	286.2	Disseminated intravascular coagulation
	286.6	Purpura fulminans
	286.9	Coagulopathy
	287.3–287.5	Thrombocytopenia, primary, secondary, or unspecified
	790.92	Abnormal coagulation profile
Metabolic	276.2	Acidosis, metabolic or lactic