A subset of cardiac surgery patients demonstrates impaired adaptation to the perioperative inflammatory response, placing them at increased risk for AF both early after surgery and following discharge.
Key Findings
Results
Prolonged SIRS occurred in 6.3% of cardiac surgery patients in the CAREBANK biobank study.
982 total patients underwent cardiac surgery from 2016 to 2021
824 (84%) patients underwent surgery using cardiopulmonary bypass (CPB)
62 (6.3%) patients developed prolonged SIRS
Patients were prospectively enrolled with ongoing follow-up data (NCT03444259)
Results
Transfusion of packed red blood cells was independently associated with development of prolonged SIRS in multivariable analysis.
OR 1.9, 95% CI 1.1–3.5, P = .03
Finding was identified through multivariable analysis
This was one of two significant independent predictors of prolonged SIRS identified
Results
First postoperative day C-reactive protein (CRP) level was independently associated with the development of prolonged SIRS.
OR 1.2, 95% CI 1.0–1.3, per 10 units, P = .002
Finding was identified through multivariable analysis
This was the stronger of the two significant independent predictors of prolonged SIRS
Results
Patients with prolonged SIRS had significantly higher incidence of postoperative atrial fibrillation during index hospitalization compared to non-SIRS patients.
OR 2.4, 95% CI 1.4–4.0, P < .001
Higher incidence of postoperative AF was the main driver of more adverse events during index hospitalization in prolonged SIRS patients
Prolonged SIRS patients had more adverse events overall during index hospitalization
Results
At 2 years post-discharge, patients with prolonged SIRS had a higher incidence of atrial fibrillation compared to non-SIRS patients.
Hazard ratio 2.0, 95% CI 1.1–3.6, P = .024
The elevated risk extended beyond the immediate postoperative period to long-term follow-up at 2 years
This finding suggests prolonged SIRS is associated with both short- and long-term AF risk