Impact of Low-Dose Hydrocortisone on the Incidence of Atrial Fibrillation in Patients With Septic Shock: A Propensity Score-Inverse Probability of Treatment Weighting Cohort Study

Launey, Yoann; Lasocki, Sigismond; Asehnoune, Karim; Gaudriot, Baptiste; Chassier, Claire; Cinotti, Raphaël; Maguet, Pascale Le; Laksiri, Leila; Mimoz, Olivier; Tawa, Audrey; Nesseler, Nicolas; Malledant, Yannick; Perrot, Bastien; Séguin, Philippe

doi:10.1177/0885066617696847

Cited by 23 publications

(42 citation statements)

References 40 publications

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“…In a recent, prospective nonrandomized study, the administration of hydrocortisone in patients with septic shock was associated with lower rates of new-onset AF following propensity score matching. 73 Randomized trials have shown lower rates of new-onset AF following cardiac surgery in patients administered magnesium infusions, glucocorticoids, and BBs 23,55,74 ; it is unknown whether these strategies are of benefit in a general ICU population. Specific therapies to reduce AF during critical illness cannot be recommended at this time.…”

Section: Approaches To Long-term Managementmentioning

confidence: 99%

Atrial Fibrillation in the ICU

Bosch

Cimini

Walkey

2018

Chest

201

216

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Atrial fibrillation (AF) is the most common arrhythmia encountered in the ICU. Preexisting AF is highly prevalent among older patients with chronic conditions who are at risk for critical illness, whereas new-onset AF can be triggered by accelerated atrial remodeling and arrhythmogenic triggers encountered during critical illness. The acute loss of atrial systole and onset of rapid ventricular rates that characterize new-onset AF often lead to decreased cardiac output and hemodynamic compromise. Thus, new-onset AF is both a marker of disease severity as well as a likely contributor to poor outcomes, similar to other manifestations of organ dysfunction during critical illness. Evaluating immediate hemodynamic effects of new-onset AF during critical illness is an important component of rapid clinical assessment aimed at identifying patients in need of urgent direct current cardioversion, treatment of reversible inciting factors, and identification of patients who may benefit from pharmacologic rate or rhythm control. In addition to acute hemodynamic effects, new-onset AF during critical illness is associated with both short- and long-term increases in the risk of stroke, heart failure, and death, with AF recurrence rates of approximately 50% within 1 year following hospital discharge. In the absence of a strong evidence base, there is substantial practice variation in the choice of strategies for management of new-onset AF during critical illness. We describe acute and long-term evaluation and management strategies based on current evidence and propose future avenues of investigation to fill large knowledge gaps in the management of patients with AF during critical illness.

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Section: Approaches To Long-term Managementmentioning

confidence: 99%

Atrial Fibrillation in the ICU

Bosch

Cimini

Walkey

2018

Chest

201

216

View full text Add to dashboard Cite

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“…60 Moreover, the use of statins before surgery in patients who underwent major lung or esophageal resection was associated with lower incidence of new-onset AF in a prospective study. 61 In patients with septic shock, Launey et al 62 reported that administration of low-dose hydrocortisone was associated with a lower risk of developing AF during the acute phase of septic shock (hydrocortisone group 16.8%, nonhydrocortisone group 28.8%, p ¼ 0.40). Nevertheless, evidence for the effect of possible preventive measures against new-onset AF in sepsis patients is lacking and further research is needed to make any recommendation in this respect.…”

Section: Prevention Of New-onset Afmentioning

confidence: 99%

New-Onset Atrial Fibrillation in Sepsis: A Narrative Review

Aibar

Schulman

2020

Semin Thromb Hemost

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Atrial fibrillation (AF) is a frequently identified arrhythmia during the course of sepsis. The aim of this narrative review is to assess the characteristics of patients with new-onset AF related to sepsis and the risk of stroke and death, to understand if there is a need for anticoagulation. We searched for studies on AF and sepsis on PubMed, the Cochrane database, and Web of Science, and 17 studies were included. The mean incidence of new-onset AF in patients with sepsis was 20.6% (14.7% in retrospective studies and 31.6% in prospective). Risk factors for new-onset AF included advanced age, white race, male sex, obesity, history of cardiopulmonary disease, heart or respiratory failure, and higher disease severity score. In-hospital mortality was higher in patients with than in those without new-onset AF in 10 studies. In four studies the overall intensive care unit and hospital mortality rates were comparable between patients with and without new-onset AF, while three other studies did not provide mortality data. One study reported on the in-hospital incidence of stroke, which was 2.6 versus 0.69% in patients with or without new-onset AF, respectively. Seven of the studies provided follow-up data after discharge. In three studies, new-onset AF was associated with excess mortality at 28 days, 1 year, and 5 years after discharge of 34, 21, and 3% patients, respectively. In two studies, the mortality rate was comparable in patients with and without new-onset AF. Postdischarge stroke was reported in five studies, whereof two studies had no events after 30 and 90 days, one study showed a nonsignificant increase in stroke, and two studies demonstrated a significant increase in risk of stroke after new-onset AF. The absolute risk increase was 0.6 to 1.6%. Large prospective studies are needed to better understand the need for anticoagulation after new-onset AF in sepsis.

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“…16 Studies examining catecholamine-sparing strategies, such as the addition of vasopressin or stress-dose steroids, also suggest a benefit which may be due to minimization of b-1 stimulation. [21][22][23][24][25] In the Vasopressin versus Norepinephrine Infusion in Patients with Septic Shock study, patients in the vasopressin group had significantly lower heart rates during the first 4 days compared to the norepinephrine group (P < .001), although this did not translate into a mortality benefit. 21 Two dose-finding studies evaluating the addition of vasopressin to norepinephrine found similar reductions in heart rate.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, corticosteroids, which also reduce catecholamine requirements, have been described to reduce the incidence of AF in septic shock. 25 Further untoward effects potentially mediated by b-1 stimulation may include suppression of immune function, increased production of inflammatory cytokines, and potentiation of pathogen virulence. 26 Blunting endogenous and exogenous b-1 signaling has been shown to elicit positive effects in septic shock.…”

Section: Discussionmentioning

confidence: 99%

Does Switching Norepinephrine to Phenylephrine in Septic Shock Complicated by Atrial Fibrillation With Rapid Ventricular Response Improve Time to Rate Control?

Haiduc

Radparvar

Aitken

et al. 2020

J Intensive Care Med

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Background: Atrial fibrillation (AF) frequently develops during critical illness. In septic shock complicated by rapid AF, the use of phenylephrine may be advantageous secondary to its β-1 sparing properties. However, evidence supporting this strategy is lacking. Objective: The purpose of this study is to determine the clinical effect on rate control of transitioning norepinephrine to phenylephrine in septic shock patients who develop AF with a rapid ventricular response (RVR). Methods: A single-center retrospective study of septic shock patients admitted to the medical or surgical intensive care unit (ICU) who developed AF with RVR (heart rate >110 beats per minute [bpm]). Patients who were switched to phenylephrine were compared to those who remained on norepinephrine. The primary end point was sustained achievement of rate control. A time-varying Cox proportional hazards model was used to assess the primary end point. Results: A total of 67 patients were included in the study, of which 28 were switched to phenylephrine. Baseline characteristics were similar between groups. The unadjusted hazard ratio for achieving rate control was significant at 1.99 (95% confidence interval [CI]: 1.19-3.34; P < .01) for the phenylephrine group. The adjusted hazard ratio was 1.75 (95% CI: 0.86-3.53; P = .12). There were no statistically significant differences in mortality or ICU length of stay. Conclusion: Our study suggests a potential clinical effect on achieving rate control when switching to phenylephrine cannot be excluded. It remains unclear if there is a benefit on mortality or length of stay outcomes in critically ill patients.

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Impact of Low-Dose Hydrocortisone on the Incidence of Atrial Fibrillation in Patients With Septic Shock: A Propensity Score-Inverse Probability of Treatment Weighting Cohort Study

Abstract: In patients with septic shock, low-dose hydrocortisone was associated with a lower risk of developing AF during the acute phase.

Cited by 23 publications

References 40 publications

Atrial Fibrillation in the ICU

Atrial Fibrillation in the ICU

New-Onset Atrial Fibrillation in Sepsis: A Narrative Review

Does Switching Norepinephrine to Phenylephrine in Septic Shock Complicated by Atrial Fibrillation With Rapid Ventricular Response Improve Time to Rate Control?

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