ASSOCIATION BETWEEN PNEUMONIA SEVERITY AND ATRIAL FIBRILLATION: EXPLORING THE RELATIONSHIP BETWEEN INFLAMMATORY BURDEN AND ARRHYTHMOGENESIS

Abstract

Objectives:
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia worldwide and is frequently observed in critically ill patients, including those with community-acquired pneumonia (CAP). This study aimed to evaluate the association between pneumonia severity and the occurrence of new-onset atrial fibrillation, with particular emphasis on the role of systemic inflammatory burden in arrhythmogenesis.

Methodology:
An observational analytical study was conducted in a tertiary care hospital. Adult patients admitted with CAP were included, while those with pre-existing chronic AF, structural heart disease, or incomplete records were excluded. Data were collected retrospectively using non-probability consecutive sampling. Pneumonia severity was assessed using standardized scoring systems (CURB-65/PSI) and categorized as mild, moderate, or severe. Demographic variables, clinical outcomes, electrocardiographic findings, and inflammatory markers—including C-reactive protein (CRP), white blood cell count, erythrocyte sedimentation rate (ESR), and serum interleukins—were analyzed. Statistical analysis included chi-square tests, t-tests, ANOVA, and multivariable regression, with a p-value <0.05 considered significant.

Results:
A total of 180 patients were analyzed (mean age 61.4 ± 14.2 years; 58.3% males). New-onset AF occurred in 38 patients (21.1%) and increased significantly with pneumonia severity (p <0.001). Patients with AF demonstrated significantly higher inflammatory marker levels, longer hospital stays, and worse clinical outcomes. Regression analysis identified elevated CRP and serum interleukin levels as independent predictors of AF after adjusting for age and pneumonia severity.

Conclusion:
Pneumonia severity is strongly associated with the development of new-onset atrial fibrillation, and systemic inflammation plays a key role in this relationship. Early identification of high-risk patients using inflammatory markers may improve risk stratification and clinical outcomes in CAP.