Risk Factors and Prognostic Implications of New-Onset Paroxysmal Atrial Fibrillation in Patients Hospitalized with Intracerebral Hemorrhage

Figures & data

Table 1 Baseline Characteristics of Patients with Intracerebral Hemorrhage with and without New-Onset PAF

Characteristics	Patients without PAF N=626	Patients with PAF N=24	P value
Gender, female, n (%)	201 (32.1%)	8 (33.3%)	0.899
Age, years (mean ± SD)	60.2 ± 14.4	74.0 ± 12.0	<0.001
ICU admission, n (%)	117 (18.7%)	8 (33.3%)	0.074
Time from symptom onset to admission
<24 hours	121 (19.3%)	10 (41.7%)	0.016
1–3 day	412 (65.8%)	14 (58.3%)	0.591
3–7 day	93 (14.9%)	0 (0.0%)	0.036
Hematoma location, n (%)
Lobar	145 (23.2%)	10 (41.7%)	0.065
Deep	396 (63.3%)	12 (50.0%)	0.278
Infratentorial	85 (13.6%)	2 (8.3%)	0.758
Insular damage, n (%)	80 (12.8%)	6 (25.0%)	0.083
Hematoma volume, mL; median (IQR)	10.0 (3.9–25.0)	31.8 (13.3–61.1)	0.002
Presence of IVH, n (%)	189 (30.2%)	13 (54.2%)	0.013
Presence of SAH, n (%)	41 (6.6%)	3 (12.5%)	0.217
Hypertension, n (%)	552 (88.2%)	22 (91.7%)	1.000
Diabetes mellitus, n (%)	145 (23.2%)	5 (20.8%)	0.790
Heart failure, n (%)	7 (1.1%)	6 (25.0%)	<0.001
Pneumonia, n (%)	173 (27.6%)	20 (83.3%)	<0.001
Coronary heart disease, n (%)	44 (7.0%)	4 (16.7%)	0.093
Smoking status: Current, n (%)	152 (24.3%)	4 (16.7%)	0.474
SBP, mmHg; median (IQR)	154 (140–170)	152 (136–162)	0.220
Creatinine, mmol/L; median (IQR)	78.0 (62.0–100.0)	94.0 (64.5–147.0)	0.144
Glucometer, mmol/L; median (IQR)	6.0 (5.1–7.6)	6.4 (5.2–8.5)	0.494
Surgery interventions, n (%)	68 (10.9%)	3 (12.5%)	0.738
In-hospital mortality, n (%)	24 (3.8%)	3 (12.5%)	0.072
Length of hospital stay, day; median (IQR)	14 (10–20)	17 (12–32)	0.126
mRS at discharge, median (IQR)	4 (2–4)	4 (4–5)	<0.001
GCS score, median (IQR)	15 (10–15)	9 (5–11)	<0.001
Duration of CEM, day; median (IQR)	9 (5–14)	15 (9–23)	0.005
Total patients with baseline NT-proBNP	405	23
NT-proBNP, pg/mL; median (IQR)	160 (69–514)	647 (268–2328)	<0.001

Abbreviations: PAF, paroxysmal atrial fibrillation; SD, standard deviation; ICU, intensive care unit; IQR, interquartile range; IVH, intraventricular hemorrhage; SAH, subarachnoid hemorrhage; SDP, systolic blood pressure; mRS, modified Rankin score; GCS, Glasgow Coma Scale; CEM, continuous stroke unit electrocardiography monitoring; NT-proBNP, N-terminal prohormone of brain natriuretic peptide.

Figure 1 Study flow chart.

Abbreviations: ICH, intracerebral hemorrhage; AF, atrial fibrillation; IVH, intraventricular hemorrhage.

Table 2 Univariable Regression Model of Risk Factors for New-Onset PAF in Patients with Intracerebral Hemorrhage

Variables	OR (95% CI)	P value
Gender, female	0.95 (0.40–2.25)	0.900
Age (per 10-y increase)	2.50 (1.69–3.68)	<0.001^a
Insular damage	2.27 (0.88–5.90)	0.091^b
Hematoma volume (per 10-mL increase)	1.63 (1.19–2.24)	0.003^a
Coronary heart disease	2.65 (0.87–8.08)	0.088^b
Hypertension	1.47 (0.34–6.40)	0.604
Diabetes mellitus	0.87 (0.32–2.38)	0.791
Heart failure	29.48 (9.00–96.59)	<0.001^a
Duration of CEM	1.03 (1.01–1.05)	0.011^a

Notes: ^aSignificant at P<0 0.05. ^bSignificant at P<0.1 (cutoff for inclusion in multivariable models).

Abbreviations: OR, odds ratio; CI, confidence interval; CEM, continuous stroke unit electrocardiography monitoring.

Table 3 Multivariate Logistic Regression Analyses of Risk Factors for New-Onset PAF Among Patients with Intracerebral Hemorrhage

Variables	OR (95% CI)	P value
Age (per 10-y increase)	2.26 (1.52–3.35)	<0.001
Hematoma volume (per 10-mL increase)	1.80 (1.26–2.57)	0.001
Heart failure	21.77 (5.52–85.91)	<0.001

Abbreviations: OR, odds ratio; CI, confidence interval.

Table 4 Sensitivity Analysis: Multivariable Analyses of Risk Factors for New-Onset PAF Restricted to Patients with Baseline NT-proBNP Levels (n = 428)

Variables	OR (95% CI)	P value
Age (per 10-y increase)	2.16 (1.44–3.24)	<0.001
Hematoma volume (per 10-mL increase)	1.69 (1.17–2.45)	0.005
Heart failure	8.35 (1.91–36.55)	0.005
NT–proBNP (per 1-U increase on log scale)	1.32 (1.00–1.73)	0.049

Abbreviations: OR, odds ratio; CI, confidence interval; NT-proBNP, N-terminal prohormone of brain natriuretic peptide.

Table 5 Characteristics of Patients with Intracerebral Hemorrhage Stratified by Functional Outcomes at Discharge

Characteristics	Good Outcome N=313	Poor Outcome N=337	P value
Gender, female, n (%)	98 (31.3%)	111 (32.9%)	0.657
Age, years (mean ± SD)	60.2 ± 14.1	61.2 ± 14.9	0.349
New-onset PAF, n (%)	1 (0.3%)	23 (6.8%)	<0.001
ICU admission, n (%)	11 (3.5%)	114 (33.8%)	<0.001
Hematoma location, n (%)
Lobar	80 (25.6%)	75 (22.3%)	0.370
Deep	188 (60.1%)	220 (65.3%)	0.196
Infratentorial	45 (14.4%)	42 (12.5%)	0.548
Insular damage, n (%)	17 (5.4%)	69 (20.5%)	<0.001
Hematoma volume, mL; median (IQR)	6.0 (2.4–14.0)	17.2 (7.3–41.8)	<0.001
Presence of IVH, n (%)	56 (17.9%)	146 (43.3%)	<0.001
Presence of SAH, n (%)	11 (3.5%)	33 (9.8%)	0.001
Hypertension, n (%)	269 (85.9%)	305 (90.5%)	0.071
Diabetes mellitus, n (%)	67 (21.4%)	83 (24.6%)	0.330
Heart failure, n (%)	1 (0.3%)	12 (3.6%)	0.003
Pneumonia, n (%)	37 (11.8%)	156 (46.3%)	<0.001
Coronary heart disease, n (%)	25 (8.0%)	23 (6.8%)	0.571
SBP, mmHg, median (IQR)	153 (138–169)	156 (140–170)	0.245
Creatinine, mmol/L; median (IQR)	74 (62–94)	82 (63–105)	0.010
Glucometer, mmol/L; median (IQR)	5.5 (4.8–6.8)	6.7 (5.6–8.1)	<0.001
Surgery interventions, n (%)	12 (3.8%)	59 (17.5%)	<0.001
Length of hospital stay, day; median (IQR)	12 (9–15)	16 (12–25)	<0.001
GCS scores, median (IQR)	15 (15–15)	10 (6–14)	<0.001

Abbreviations: SD, standard deviation; PAF, paroxysmal atrial fibrillation; ICU, intensive care unit; IQR, interquartile range; IVH, intraventricular hemorrhage; SAH, subarachnoid hemorrhage; SBP, systolic blood pressure; GCS, Glasgow Coma Scale.

Table 6 Univariable and Multivariable Regression Model of Predictors of Poor Functional Outcome at Discharge in Patients with Intracerebral Hemorrhage

Variables	Univariable OR (95% CI)	P value	Multivariable^a OR (95% CI)	P value
Gender, female	1.08 (0.77–1.50)	0.657
Hematoma volume (per 10-mL increase)	2.05 (1.76–2.39)	<0.001	1.30 (1.05–1.60)	0.016
Age (per 10-y increase)	1.08 (0.93–1.25)	0.330
New-onset PAF	22.85 (3.07–170.20)	<0.001	10.35 (1.08–98.80)	0.042
Heart failure	11.52 (1.49–88.99)	0.019	10.81 (1.09–107.38)	0.042
Pneumonia	6.43 (4.29–9.63)	<0.001	1.93 (1.11–3.34)	0.019
Glucometer	1.11 (1.04–1.19)	0.001
GCS scores	0.47 (0.41–0.54)	0.001	0.51 (0.44–0.58)	<0.001
Presence of IVH	3.51 (2.45–5.03)	<0.001
Hematoma location
Deep	Ref	Ref
Lobar	0.80 (0.50–1.27)	0.339
Infratentorial	0.80 (0.55–1.16)	0.241
Insular damage	4.48 (2.57–7.82)	<0.001
ICU admission	14.04 (7.38–26.68)	<0.001
Presence of SAH	2.98 (1.48–6.01)	0.002
Surgery interventions	5.32 (2.80–10.11)	<0.001

Notes: ^aVariables from univariate logistic regression with P < 0.1 were included in multivariate logistic regression model using a forward stepwise logistic regression analysis and removed with P > 0.05.

Abbreviations: OR, odds ratio; CI, confidence interval; PAF, paroxysmal atrial fibrillation; GCS, Glasgow Coma Scale; IVH, intraventricular hemorrhage; Ref, reference; ICU, intensive care unit; SAH, subarachnoid hemorrhage.