Abstract
IntroductionCritically ill patients with sepsis are prone to develop cardiac dysrhythmias, most commonly atrial fibrillation (AF). Systemic inflammation, circulating stress hormones, autonomic dysfunction, and volume shifts are all possible triggers for AF in this setting. We conducted a systematic review to describe the incidence, risk factors and outcomes of new-onset AF in patients with sepsis.MethodsMEDLINE, EMBASE and Web Of Science were searched for studies reporting the incidence of new-onset AF, atrial flutter or supraventricular tachycardia in patients with sepsis admitted to an intensive care unit, excluding studies that primarily focused on postcardiotomy patients. Studies were assessed for methodological quality using the GRADE system. Risk factors were considered to have a high level of evidence if they were reported in ≥2 studies using multivariable analyses at a P value <0.05. Subsequently, the strength of association was classified as strong, moderate or weak, based on the reported odds ratios.ResultsEleven studies were included. Overall quality was low to moderate. The weighted mean incidence of new-onset AF was 8% (range 0 to 14%), 10% (4 to 23%) and 23% (6 to 46%) in critically ill patients with sepsis, severe sepsis and septic shock, respectively. Independent risk factors with a high level of evidence included advanced age (weak strength of association), white race (moderate association), presence of a respiratory tract infection (weak association), organ failure (moderate association), and pulmonary artery catheter use (moderate association). Protective factors were a history of diabetes mellitus (weak association) and the presence of a urinary tract infection (weak association). New-onset AF was associated with increased short-term mortality in five studies (crude relative effect estimates ranging from 1.96 to 3.32; adjusted effects 1.07 to 3.28). Three studies reported a significantly increased length of stay in the ICU (weighted mean difference 9 days, range 5 to 13 days), whereas an increased risk of ischemic stroke was reported in the single study that looked at this outcome.ConclusionsNew-onset AF is a common consequence of sepsis and is independently associated with poor outcome. Early risk stratification of patients may allow for pharmacological interventions to prevent this complication.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-014-0688-5) contains supplementary material, which is available to authorized users.
Highlights
Ill patients with sepsis are prone to develop cardiac dysrhythmias, most commonly atrial fibrillation (AF)
The incidences of new-onset AF in patients with sepsis admitted to the intensive care unit (ICU) that we found in our systematic review are higher than the 4 to 9% occurrence rates reported for general ICU populations, but lower than the estimated 30 to 50% rate in postcardiotomy patients [1-3]
New-onset AF is a common occurrence in critically ill patients with sepsis, and its incidence rises with increasing severity of disease
Summary
Ill patients with sepsis are prone to develop cardiac dysrhythmias, most commonly atrial fibrillation (AF). Systemic inflammation, circulating stress hormones, autonomic dysfunction, and volume shifts are all possible triggers for AF in this setting. New-onset atrial fibrillation (AF) is a common complication of critical illness, with a reported incidence that varies from 4 to 9% in general intensive care unit (ICU) patients to 32 to 50% in postcardiotomy patients [1-3]. Intravascular volume shifts and cardiovascular compromise will frequently lead to hypotension and elevated lactate levels [11]. All of these features of sepsis are possible triggers for the development of AF [12]
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