Department of Medicine, Boston University School of Medicine, The Pulmonary Center, Boston, MA.
Department of Medicine, Center for Implementation and Improvement Sciences, Boston University School of Medicine, Boston, MA.
Crit Care Med. 2019 Feb;47(2):280-287. doi: 10.1097/CCM.0000000000003560.
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.
Medline, Embase, Web of Science, and Cochrane CENTRAL.
We conducted a systematic review and meta-analysis to identify risk factors for new-onset atrial fibrillation during sepsis.
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.
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.
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.
心房颤动常发生于脓毒症患者，与发病率和死亡率增加有关。不幸的是，脓毒症患者新发心房颤动的危险因素尚未明确。阐明脓毒症期间发生心房颤动的危险因素可能有助于我们理解心律失常发生的机制，并指导临床实践。
Medline、Embase、Web of Science 和 Cochrane CENTRAL。
我们进行了系统评价和荟萃分析，以确定脓毒症患者新发心房颤动的危险因素。
我们提取了与脓毒症患者新发心房颤动相关的每个危险因素的调整比值比。对于存在于多项研究中的危险因素，我们计算了汇总比值比（荟萃分析）。我们根据类型对危险因素进行分类，并量化了危险因素的效应大小。然后，我们比较了与脓毒症相关的心房颤动危险因素与社区相关心房颤动的危险因素。
共检查了 44 个因素作为脓毒症患者新发心房颤动的可能危险因素，其中 18 个因素纳入了荟萃分析。新发心房颤动的危险因素包括人口统计学因素、合并症，以及最强的与脓毒症相关的因素。与新发心房颤动的odds 比变化超过 50%的与脓毒症相关的因素包括皮质类固醇使用、右心导管检查、真菌感染、血管加压素使用以及平均动脉压目标为 80-85mmHg。几种已知是社区相关心房颤动的危险因素的心血管疾病并未被确定为脓毒症患者新发心房颤动的危险因素。
我们的研究表明，脓毒症患者新发心房颤动的危险因素主要是与急性脓毒症事件相关的因素，与社区相关心房颤动的危险因素并不相同。我们的结果为未来专注于心房颤动预防的研究提供了目标，并对脓毒症患者管理的几个关键领域产生了影响，如糖皮质激素的使用、血管加压素的选择和血压目标。
