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Risk Factors for New-Onset Atrial Fibrillation in Patients With Sepsis

A Systematic Review and Meta-Analysis

Bosch, Nicholas A., MD1; Cohen, David M., MD1; Walkey, Allan J., MD, MSc1,2

doi: 10.1097/CCM.0000000000003560
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Objective: Atrial fibrillation frequently develops in patients with sepsis and is associated with increased morbidity and mortality. Unfortunately, risk factors for new-onset atrial fibrillation in sepsis have not been clearly elucidated. Clarification of the risk factors for atrial fibrillation during sepsis may improve our understanding of the mechanisms of arrhythmia development and help guide clinical practice.

Data Sources: Medline, Embase, Web of Science, and Cochrane CENTRAL.

Study Selection: We conducted a systematic review and meta-analysis to identify risk factors for new-onset atrial fibrillation during sepsis.

Data Extraction: We extracted the adjusted odds ratio for each risk factor associated with new-onset atrial fibrillation during sepsis. For risk factors present in more than one study, we calculated pooled odds ratios (meta-analysis). We classified risk factors according to type and quantified the factor effect sizes. We then compared sepsis-associated atrial fibrillation risk factors with risk factors for community-associated atrial fibrillation.

Data Synthesis: Forty-four factors were examined as possible risk factors for new-onset atrial fibrillation in sepsis, 18 of which were included in meta-analyses. Risk factors for new-onset atrial fibrillation included demographic factors, comorbid conditions, and most strongly, sepsis-related factors. Sepsis-related factors with a greater than 50% change in odds of new-onset atrial fibrillation included corticosteroid use, right heart catheterization, fungal infection, vasopressor use, and a mean arterial pressure target of 80–85 mm Hg. Several cardiovascular conditions that are known risk factors for community-associated atrial fibrillation were not identified as risk factors for new-onset atrial fibrillation in sepsis.

Conclusions: Our study shows that risk factors for new-onset atrial fibrillation during sepsis are mainly factors that are associated with the acute sepsis event and are not synonymous with risk factors for community-associated atrial fibrillation. Our results provide targets for future studies focused on atrial fibrillation prevention and have implications for several key areas in the management of patients with sepsis such as glucocorticoid administration, vasopressor selection, and blood pressure targets.

1Department of Medicine, Boston University School of Medicine, The Pulmonary Center, Boston, MA.

2Department of Medicine, Center for Implementation and Improvement Sciences, Boston University School of Medicine, Boston, MA.

Dr. Bosch takes responsibility for the integrity of the work as a whole, from inception to published article, and he drafted the article. Drs. Bosch and Walkey substantially contributed to the conception and design of this study. Drs. Bosch and Cohen acquired the data. Drs. Bosch, Cohen, and Walkey were involved in the interpretation of data and revised it critically for important intellectual content.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Supported, in part, by National Heart, Lung, and Blood Institute grants 5K01HL116768-03 and 1R01HL136660-01 (to Dr. Walkey).

Dr. Walkey’s institution received funding from the National Institutes of Health (NIH)/National Heart, Lung, and Blood Institute; he received royalties from UptoDate; and he received support for article research from the NIH. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: nicholas.bosch@bmc.org

Copyright © by 2019 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.