Prolonged Systemic Inflammatory Response Syndrome Predicts Atrial Fibrillation After Cardiac Surgery.

Area of Science:

• Cardiology
• Immunology
• Surgical Science

Background:

• Cardiac surgery, especially with cardiopulmonary bypass (CPB), can trigger an inflammatory response.
• Some patients exhibit impaired adaptation, leading to prolonged systemic inflammatory response (SIRS).
• The link between prolonged SIRS and postoperative atrial fibrillation (AF) requires further investigation.

Purpose of the Study:

• To identify risk factors for prolonged SIRS after adult cardiac surgery.
• To determine if prolonged SIRS influences the incidence of short- and long-term postoperative AF.

Main Methods:

• Prospective enrollment of adult cardiac surgery patients (2016-2021) in the CAREBANK biobank study.
• Substudy analysis including patients who underwent surgery with or without CPB.
• Multivariable analysis to identify risk factors for prolonged SIRS and its association with AF.

Main Results:

• Prolonged SIRS occurred in 6.3% of 982 patients.
• Transfusion of packed red blood cells and elevated postoperative C-reactive protein levels were risk factors for prolonged SIRS.
• Patients with prolonged SIRS had a significantly higher incidence of early (OR 2.4) and two-year post-discharge AF (HR 2.0).

Conclusions:

• A subset of cardiac surgery patients shows inadequate adaptation to perioperative inflammation.
• This impaired inflammatory response increases the risk of both early and late postoperative atrial fibrillation.
• Targeting SIRS may be a strategy to reduce AF incidence in cardiac surgery patients.