Abstract
INTRODUCTION: Atrial fibrillation (AF) is the commonest arrhythmia in septic shock. NOAF is common during first 72 hours of the septic shock.(, ) An exact cause of this is not known, although inflammation is the proposed cause by many. OBJECTIVES: Our aim of study was to observe NLR values on day 1, 3 and 5 of all patients with septic shock and to evaluate the predictive value of NLR to detect NOAF in such patients. MATERIALS AND METHODS: All patients admitted in critical care units, who had septic shock or develop septic shock during their stay were assessed for eligibility. Exclusion criteria were: Neutropenia (ANC < 1500). Immunocompromised status due to chemotherapy, radiotherapy, long term steroids [prednisone > 75 mg/day or equivalent steroids for atleast one week]. Stem cell or bone marrow transplant or solid organ transplant recipient. Pregnancy. Pre- existing AF or valvular heart disease. Shock due to other causes- cardiogenic, hemorrhagic, neurogenic. NOAF was classified as isolated: only one episode which resolved within 2 hours. recurrent: recurred within 2 hours of initial successful treatment. prolonged: AF persisted beyond 24 hours but less than 24 hours. persistent: AF persisted beyond 24 hours. 97 patients were enrolled in the study. NLR values (absolute number of neutrophils divided by absolute number of lymphocytes) was calculated from hemogram done on day 1, day 3 and day 5 of septic shock. Continuous ECG monitoring was done to look for new onset of atrial fibrillation. Patients were managed as per the treating consultant. NLR value =/> 3.53 (normal value is 0.78 to 3.53(, )) was considered as positive value/test. Occurrence of NOAF, day of onset, type, length of ICU stay and resolution of shock was recorded. RESULTS: 48.5% patients with septic shock had NOAF. Patients with NOAF had mortality 61.7%. High mortality was seen in persistent NOAF (88.9%). Majority of the patients with NOAF had high NLR mean on day 1(20.04±11.9) compared with day 3 (19.7±11.5) and 5 (16.6±9.9) and among patients without NOAF, the mean NLR was high on day 3 (17.3±12.6) compared with day 1 (16.3±13.1) and 5 (14.2±10.1). Resolution of shock was seen in 40.4% of the patients with NOAF; of these 17.5% had isolated NOAF. Majority of the patients had NOAF on day 1 and day 2 (19.6%). Sensitivity analysis was done for NLR on day 1, 3 and 5. (Table 1). ROC curve analysis showed that AUC was as follows: (Figure 1). CONCLUSIONS: The cut off value of 3.5 on day 3 as a predictor of AF has high sensitivity compared with day 1 and 5. NLR has a good sensitivity to detect NOAF in septic shock but not good specificity.