Prevalence of New-Onset Atrial Fibrillation and Associated Outcomes in Patients with Sepsis: A Systematic Review and Meta-Analysis

Abstract

Background: New-onset atrial fibrillation (NOAF) is a common complication in patients with sepsis, although its prevalence and impact on outcomes are still unclear. We aim to provide a systematic review and meta-analysis on the prevalence of NOAF in patients with sepsis, and its impact on in-hospital mortality and intensive care unit (ICU) mortality. Methods: PubMed and EMBASE were systematically searched on 26 December 2021. Studies reporting on the prevalence of NOAF and/or its impact on in-hospital mortality or ICU mortality in patients with sepsis or septic shock were included. The pooled prevalence and 95% confidence intervals (CI) were calculated, as well as the risk ratios (RR), 95%CI and 95% prediction intervals (PI) for outcomes. Subgroup analyses and meta-regressions were performed to account for heterogeneity. Results: Among 4988 records retrieved from the literature search, 22 articles were included. Across 207,847 patients with sepsis, NOAF was found in 13.5% (95%CI: 8.9–20.1%), with high heterogeneity between studies; significant subgroup differences were observed, according to the geographical location, study design and sample size of the included studies. A multivariable meta-regression model showed that sample size and geographical location account for most of the heterogeneity. NOAF patients showed an increased risk of both in-hospital mortality (RR: 1.69, 95%CI: 1.47–1.96, 95%PI: 1.15–2.50) and ICU mortality (RR: 2.12, 95%CI: 1.86–2.43, 95%PI: 1.71–2.63), with moderate to no heterogeneity between the included studies. Conclusions: NOAF is a common complication during sepsis, being present in one out of seven individuals. Patients with NOAF are at a higher risk of adverse events during sepsis, and may need specific therapeutical interventions.

New Paradigms in Antithrombotic Strategies: A Leap into the Future of Cardiovascular Medicine

“…A systematic review and meta-analysis of 31 studies showed how new-onset AF represents a common complication in COVID-19 patients, being found in up to 8% of hospitalized patients, and also showed that AF is associated with a significant increase in the risk of all-cause mortality [ 5 ]. These results are in accordance with those found in other similar scenarios, such as sepsis [ 6 , 7 , 8 ] and community-acquired pneumonia [ 9 ], and offer an interesting outlook on the relationship between infections, inflammation, and cardiovascular disease, all being connected by thrombosis [ 10 ]. On the other hand, Protasiewicz et al reported a retrospective analysis on the impact of anticoagulation before the SARS-CoV-2 infection on the clinical course and outcome of COVID-19; while being limited by low statistical power, the authors did not find any statistically significant difference according to the anticoagulation status [ 11 ].…”

Fibrilação Atrial e Sepse em Pacientes Idosos e sua Associação com Mortalidade Intra-hospitalar

“…Já em Meierhenrich et al, 9 foram selecionados apenas pacientes com choque séptico e foi encontrada uma incidência de 46% de FA nova, 10 vezes mais do que aqueles pacientes com sepse sem evolução para choque. Entretanto, mais recentemente, a metanálise conduzida por Corica et al, 18 demonstrou prevalência de FA nova em pacientes sépticos de 13,5%, semelhante à do presente estudo. Essa variabilidade pode ser explicada pelos inúmeros critérios de inclusão e diferentes populações abordadas.…”

Prevalence of new-onset atrial fibrillation in hospitalized patients with community-acquired pneumonia: a systematic review and meta-analysis

“…Moreover, inflammation may be a key driver of the increased risk of newAF in these patients [ 7 ], as observed also in other clinical scenarios [ 31 ]. Unsurprisingly, the onset of AF has been repeatedly described during sepsis [ 6 , 32 ], a condition in which increased expression of inflammatory cytokines (including Interleukin-6 (IL-6), IL-8, and Tumor necrosis factor α) is thought to contribute to left atrial electric remodeling which in turns increases the risk of AF [ 7 , 33 , 34 ]. This pathophysiological hypothesis can be applied also to CAP and may explain the findings observed in our study.…”

“…Indeed, among cardiac arrhythmias, new-onset atrial fibrillation (newAF)—defined as a new or first detectable episode of a chaotic and irregular atrial rhythm, whether symptomatic or not [ 5 ], usually confirmed through 12-lead ECG—can be frequently observed during acute respiratory infection and has been repeatedly associated with increased mortality in CAP patients, especially in critically ill ones [ 6 ]. The pathophysiological link between newAF and infections could be explained by the systemic inflammatory response and the pro-inflammatory cytokines cascade causing both structural and electrical atrial remodeling which increases the risk for newAF [ 7 ].…”