Related Experiment Video
Updated: Jul 16, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Association Between Endogenous Ketosis and Risk of Atrial Fibrillation in Intensive Care Versus General Ward
Kellina Maduray1, Jingquan Zhong1
1State Key Laboratory for Innovation and Transformation of Luobing Theory, Key Laboratory of Cardiovascular Remodeling and Function Research of Chinese Ministry of Education, Chinese National Health Commission, Chinese Academy of Medical Sciences and Shandong Province, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Department of Cardiology, Qilu Hospital of Shandong University (Qingdao), Qingdao 266035, China.
Abstract:
Background: Metabolic reprogramming in critical illness and the physiological stress of general hospitalization represent fundamentally different states, yet it remains unknown if ketosis acts as a protective shield or a maladaptive metabolic response in the development of atrial fibrillation (AF) across these contexts. We examined urine and serum β-hydroxybutyrate measurements to understand the metabolic association among intensive care unit (ICU) and general hospital populations. Methods: This retrospective cohort study utilized the MIMIC-IV v3.1 database. Patients with preexisting AF or flutter were excluded. Ketosis was defined as urine ketone positivity (≥20 mg/dL) or serum β-hydroxybutyrate (≥1.0 mmol/L). The final analytic cohort included a general ward cohort (n = 13,641) and an ICU cohort (n = 10,251). Multivariable logistic regression, propensity score matching and subgroup analyses were performed. Results: In the ICU cohort, urine ketone positivity and elevated serum β-hydroxybutyrate were associated with lower incidence of AF (5.2% vs. 6.8%, p = 0.001; 3.1% vs. 9.4%, p = 0.034). After adjustment, urine ketone positivity remained independently associated with reduced odds of incident AF (adjusted OR 0.79, 95% CI 0.64-0.98, p = 0.032). Propensity-matched analyses demonstrated protective associations for urine ketones (OR 0.68, 95% CI 0.52-0.88, p = 0.004) and β-hydroxybutyrate (OR 0.24, 95% CI 0.08-0.70, p = 0.003). In contrast, urine ketone positivity in the general ward cohort was associated with higher incident AF (0.9% vs. 0.5%, p = 0.019) and increased adjusted odds (OR 2.62, 95% CI 1.03-6.66, p = 0.044). Urinary ketosis was associated with lower mortality and reduced inflammatory marker profiles across both the ICU and general ward cohorts. Subgroup analyses revealed directionally consistent ketone-AF associations across biological sex with no significant interaction effects. Conclusions: Endogenous ketones demonstrated a context-dependent association with incident AF across clinical acuity levels. These findings highlight ketone metabolism as a potential target for both arrhythmia monitoring and prevention.