Background
Methods
Study population
Diagnosis of sepsis and its severity
Detection and management of NeOAF
Statistical analyses
Results
Study population and incidence of NeOAF
Baseline characteristics of patients with sepsis and different AF status
Characteristics | Overall patients (n = 503) |
P value | ||
---|---|---|---|---|
No NeOAF (n = 263) | NeOAF to SR (n = 165) | NeOAF to AF (n = 75) | ||
Age, years | 69.5 ± 15.6 | 77.8 ± 10.3† | 76.2 ± 11.0a
| <0.01 |
Male, n (%) | 174 (66.2) | 90 (54.5)† | 46 (61.3) | 0.06 |
Comorbidities, n (%) | ||||
Hypertension | 145 (55.1) | 111 (67.3)† | 44 (58.7) | 0.04 |
Heart failure | 25 (9.5) | 35 (21.2)† | 15 (20.0)a
| <0.01 |
Coronary artery disease | 90 (34.2) | 70 (42.4) | 37 (49.3)a
| 0.04 |
Cerebrovascular disease | 56 (21.3) | 53 (32.1)† | 23 (30.7) | 0.03 |
COPD | 52 (19.8) | 28 (17.0) | 12 (16.0) | 0.66 |
Diabetes mellitus | 97 (36.9) | 65 (39.4) | 21 (28.0) | 0.23 |
Uremia | 18 (6.8) | 17 (10.3) | 9 (12.0) | 0.26 |
Thyroid disorder | 10 (3.8) | 10 (6.1) | 6 (8.0) | 0.29 |
Prior medication, n (%) | ||||
Beta blocker | 29 (11.0) | 27 (16.4) | 4 (5.3)b
| 0.04 |
Calcium channel blocker | 9 (3.4) | 10 (6.1) | 2 (2.7) | 0.32 |
Overall patients (n = 503) |
P value | |||
---|---|---|---|---|
No NeOAF (n = 263) | NeOAF to SR (n = 165) | NeOAF to AF (n = 75) | ||
Laboratory | ||||
WBC (×103/L) | 13.47 ± 8.73 | 13.43 ± 7.23 | 15.39 ± 11.73 | 0.22 |
CRP (mmol/L) | 12.8 ± 10.9 | 10.0 ± 9.9† | 11.2 ± 8.5 | 0.02 |
Na+ (mmol/L) | 135.6 ± 8.5 | 135.7 ± 10.1 | 136.7 ± 7.8 | 0.64 |
K+ (mmol/L) | 4.1 ± 1.0 | 4.2 ± 1.0 | 4.1 ± 0.9 | 0.46 |
Free Ca2+ (mmol/L) | 4.23 ± 0.31 | 4.35 ± 0.46 | 4.17 ± 0.68 | 0.46 |
Albumin (g/dL) | 2.7 ± 0.6 | 2.7 ± 0.6 | 2.6 ± 0.6 | 0.37 |
BNP (pg/ml) | 918.6 ± 1152.2 | 1131.3 ± 1325.6 | 1102.4 ± 1418.1 | 0.58 |
Tr-I (ng/ml) | 1.09 ± 5.92 | 1.98 ± 5.95 | 3.71 ± 13.42a
| 0.04 |
Echocardiography | ||||
LAD (mm) | 36.5 ± 7.4 | 38.4 ± 7.2† | 40.5 ± 7.2a
| <0.01 |
LVEDD (mm3) | 45.7 ± 8.0 | 46.1 ± 7.7 | 46.6 ± 7.5 | 0.73 |
LVESD (mm3) | 30.3 ± 8.0 | 30.9 ± 7.3 | 32.3 ± 8.4 | 0.22 |
LVEF < 50%, n (%) | 31 (13.7) | 29 (18.2) | 18 (27.7)† | 0.03 |
Sepsis severity in patients with different AF status
Overall patients (n = 503) |
P value | |||
---|---|---|---|---|
No NeOAF (n = 263) | NeOAF to SR (n = 165) | NeOAF to AF (n = 75) | ||
Infection site, n (%) | ||||
Respiratory tract | 168 (63.9) | 112 (67.9) | 48 (64.0) | |
Urinary tract | 57 (21.7) | 35 (21.2) | 14 (18.7) | |
Gastrointestinal | 23 (8.7) | 9 (5.5) | 5 (6.7) | |
Others | 15 (5.7) | 9 (5.5) | 8 (10.7) | |
SOFA score | 7.0 ± 3.2 | 7.6 ± 3.0 | 9.3 ± 3.2bc
| <0.01 |
APACHE II score | 21.6 ± 5.5 | 22.8 ± 5.8 | 24.6 ± 6.1b
| <0.01 |
Total organ failurea, n
| 2 (1–3) | 2 (1–3) | 3 (2–4) | |
Neurologic failure | 87 (33.1) | 49 (29.7) | 39 (52.0)bc
| <0.01 |
Circulatory failure | 118 (44.9) | 82 (49.7) | 57 (76.0)bc
| <0.01 |
Respiratory failure | 229 (87.1) | 150 (90.9) | 71 (94.7) | 0.13 |
Hepatic failure | 8 (3.0) | 4 (2.4) | 8 (10.7)bc
| <0.01 |
Renal failure | 86 (32.7) | 65 (39.4) | 39 (52.0)b
| <0.01 |
Hematologic failure | 9 (3.4) | 5 (3.0) | 4 (5.3) | 0.66 |
Vasopressor use, n (%) | ||||
Dopamine use | 95 (36.3) | 64 (38.8) | 49 (65.3)bc
| <0.01 |
Norepinephrine use | 80 (30.4) | 58 (35.2) | 48 (64.0)bc
| <0.01 |
Intervention, n (%) | ||||
Ventilator use | 221 (84.0) | 143 (86.7) | 69 (92.0) | 0.21 |
New-onset dialysis | 50 (19.0) | 35 (21.2) | 19 (25.3) | 0.48 |
Management of NeOAF in patients with sepsis
NeOAF patients (n = 240) |
P value | |||
---|---|---|---|---|
Overall (n = 240) | NeOAF to SR (n = 165) | NeOAF to AF (n = 75) | ||
Pharmacological, n (%) | ||||
Amiodarone | 80 (33.3) | 52 (31.5) | 28 (37.3) | 0.38 |
Beta-blockers | 88 (36.7) | 67 (40.6) | 21 (28.0) | 0.06 |
Non-DHP CCBsa
| 66 (27.5) | 47 (28.5) | 19 (25.3) | 0.61 |
Digoxin glycosides | 27 (11.3) | 15 (9.1) | 12 (16.0) | 0.12 |
Electrical cardioversion, n (%) | 8 (3.3) | 4 (2.4) | 4 (5.3) | 0.25 |
Clinical impact of rhythm control in patients with sepsis and NeOAF
Model | OR | 95% CI of OR |
P value |
---|---|---|---|
Model 1a
| |||
NeOAF to SR vs. no NeOAF | 1.66 | 1.04–2.66 | 0.03 |
NeOAF to AF vs. no NeOAF | 7.48 | 4.26–13.14 | <0.01 |
NeOAF to AF vs. NeOAF to SR | 4.50 | 2.52–8.04 | <0.01 |
Model 2b
| |||
NeOAF to SR vs. no NeOAF | 1.49 | 0.79–2.83 | 0.22 |
NeOAF to AF vs. no NeOAF | 3.31 | 1.54–7.13 | <0.01 |
NeOAF to AF vs. NeOAF to SR | 2.22 | 1.02–4.83 | 0.045 |
Discussion
Main findings
Association between sepsis and NeOAF
Hypothesis of rhythm control strategy in patients with sepsis and NeOAF
Treatment recommendation for NeOAF in patients with sepsis
Study limitations
Conclusion
Key messages
-
New-onset atrial fibrillation (NeOAF) is prevalent and associated with increased mortality in patients with sepsis.
-
It remains unclear whether restored sinus rhythm (SR) of NeOAF leads to better outcomes and how to suitably manage in patients with NeOAF.
-
NeOAF with failure to restore SR (but not all NeOAF) was an independent risk for in-hospital mortality in patients with sepsis.
-
Further prospective trials are warranted to elucidate the clinical implications of a rate versus a rhythm control strategy in patients with sepsis and NeOAF.