Sepsis as an independent risk factor in atrial fibrillation and cardioembolic stroke

Yiming Leng; Yalan Li; Jie Wang; Peizhi Deng; Wei Wang; Jingjing Wu; Wenjuan Wang; Chunyan Weng

doi:10.3389/fendo.2023.1056274

Sepsis as an independent risk factor in atrial fibrillation and cardioembolic stroke

Front Endocrinol (Lausanne). 2023 Jan 30:14:1056274. doi: 10.3389/fendo.2023.1056274. eCollection 2023.

Authors

Yiming Leng^{1

2}, Yalan Li^{1

2}, Jie Wang^{1

2}, Peizhi Deng^{1

2}, Wei Wang^{1

2}, Jingjing Wu^{1

2}, Wenjuan Wang¹, Chunyan Weng¹

Affiliations

¹ Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China.
² Clinical Research Center, The Third Xiangya Hospital, Central South University, Changsha, China.

Abstract

Background: Electrolyte balance is an important factor to sustain the homeostasis of human body environment and in sepsis pathogenesis. Many current cohort-based studies have already revealed that electrolyte disorder may intensify sepsis and induce stroke. However, the corresponding randomized controlled trials did not show that electrolyte disorder in sepsis has a harmful effect on stroke.

Objectives: The aim of this study was to examine the association of genetically sepsis-derived electrolyte disorder with stroke risk using meta-analysis and Mendelian randomization.

Results: In four studies (182,980 patients), electrolyte disorders were compared with stroke incidence in patients with sepsis. The pooled odds ratio (OR) of stroke is 1.79 [95% confidence interval (CI): 1.23-3.06; p < 0.05], which shows a significant association between electrolyte disorder and stroke in sepsis patients. Furthermore, in order to evaluate the causal association between stroke risk and sepsis-derived electrolyte disorder, a two-sample Mendelian randomization (MR) study was conducted. The genetic variants extracted from a genome-wide association study (GWAS) of exposure data that are strongly associated with frequently used sepsis were used as instrumental variables (IVs). Based on the IVs' corresponding effect estimates, we estimated overall stroke risk, cardioembolic stroke risk, and stroke induced by large/small vessels from a GWAS meta-analysis with 10,307 cases and 19,326 controls. As a final step to verify the preliminary MR results, we performed sensitivity analysis using multiple types of Mendelian randomization analysis.

Conclusion: Our study revealed the association between electrolyte disorder and stroke in sepsis patients, and the correlation between genetic susceptibility to sepsis and increased risk of cardioembolic stroke, hinting that cardiogenic diseases and accompanying electrolyte disorder interference in due course could help sepsis patients get more benefits in stroke prevention.

Keywords: atrial fibrillation; cardiogenic diseases; causal effect; electrolyte disorder; meta-analysis; sepsis; stroke.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Atrial Fibrillation* / complications
Atrial Fibrillation* / genetics
Electrolytes
Embolic Stroke*
Genome-Wide Association Study
Humans
Risk Factors
Sepsis* / complications
Sepsis* / genetics
Stroke* / etiology
Stroke* / genetics

Substances

Electrolytes