What does this research mean for the field?

New-onset atrial fibrillation occurs in approximately 13.5% of patients with sepsis and is associated with a significantly increased risk of both in-hospital and intensive care unit mortality. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

March 30, 2022Journal of Personalized Medicine37 citationsOpen Access

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

BCBernadette CoricaElectrophysiology GRGiulio Francesco RomitiGeneral Cardiology SBStefania BasiliVascular / Pulmonary Vascular

Structured PICO

Does new-onset atrial fibrillation increase the risk of in-hospital and ICU mortality in patients with sepsis?

Population

207,847 patients with sepsis or septic shock across 22 studies

Intervention

New-onset atrial fibrillation (NOAF) during sepsis

Comparator

Sepsis without new-onset atrial fibrillation

Outcome

Prevalence of NOAF, in-hospital mortality, and intensive care unit (ICU) mortalityhard clinical

New-onset atrial fibrillation is a common complication in sepsis (13.5%) and is associated with significantly increased risks of both in-hospital and ICU mortality.

Limitations

High heterogeneity between studies for prevalence

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.

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