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.
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机译：简介患有脓毒症的重症患者容易出现心脏节律不齐，最常见的是房颤（AF）。在这种情况下，全身性炎症，循环应激激素，植物神经功能紊乱和体量变化都是AF的可能诱因。我们进行了系统的综述，以描述败血症患者新发房颤的发生率，危险因素和结局。方法MEDLINE，EMBASE和Web of Science用于研究报告新发房颤，房扑或室上性心动过速发生率的研究。败血症患者进入重症监护病房，但主要针对切开切开术的患者的研究除外。使用GRADE系统评估研究的方法学质量。如果使用多变量分析在≥2项研究中将风险因素报告为P值<0.05，则认为这些风险因素具有较高的证据水平。随后，根据报道的比值比将关联强度分为强，中或弱。结果包括11项研究。总体质量从低到中等。重症脓毒症，严重脓毒症和败血性休克的新发房颤的加权平均发生率分别为8％（范围为0至14％），10％（4至23％）和23％（6至46％），分别。具有高水平证据的独立危险因素包括高龄（结缔强度低），白人（中等结缔），存在呼吸道感染（弱结缔），器官衰竭（中度结缔）和使用肺动脉导管（中度联想）。保护因素是糖尿病史（弱关联）和尿路感染（弱关联）。在五项研究中，新发房颤与短期死亡率增加相关（粗略的相对效应估计范围为1.96至3.32;调整后的效应为1.07至3.28）。三项研究报告了ICU的住院时间显着增加（加权平均差异为9天，范围为5到13天），而单项研究结果显示缺血性中风的风险增加。 AF是败血症的常见后果，并且与不良结局独立相关。患者的早期风险分层可能需要采取药理干预措施来预防这种并发症。电子补充材料本文的在线版本（doi：10.1186 / s13054-014-0688-5）包含补充材料，授权用户可以使用。
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