Use of the low-frequency/high-frequency ratio of heart rate variability to predict short-term deterioration in emergency department patients with sepsis

Barnaby, Douglas P.; Fernando, Shannon M.; Ferrick, Kevin J.; Herry, Christophe L.; Seely, Andrew J. E.; Bijur, Polly E.; Gallagher, E. John

doi:10.1136/emermed-2017-206625

Cited by 15 publications

(7 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The rationale for and feasibility of evaluating continuous HRV monitoring in the ED has been well described in previous studies[7, 22, 34]. Several studies had suggested that HRV changes may present as the earliest measurements before apparent clinical symptoms emerge [23, 35, 36].…”

Section: Discussionmentioning

confidence: 99%

Combining quick sequential organ failure assessment score with heart rate variability may improve predictive ability for mortality in septic patients at the emergency department

et al. 2019

View full text Add to dashboard Cite

BackgroundAlthough the quick Sequential Organ Failure Assessment (qSOFA) score was recently introduced to identify patients with suspected infection/sepsis, it has limitations as a predictive tool for adverse outcomes. We hypothesized that combining qSOFA score with heart rate variability (HRV) variables improves predictive ability for mortality in septic patients at the emergency department (ED).MethodsThis was a retrospective study using the electronic medical record of a tertiary care hospital in Singapore between September 2014 and February 2017. All patients aged 21 years or older who were suspected with infection/sepsis in the ED and received electrocardiography monitoring with ZOLL X Series Monitor (ZOLL Medical Corporation, Chelmsford, MA) were included. We fitted a logistic regression model to predict the 30-day mortality using one of the HRV variables selected from one of each three domains those previously reported as strong association with mortality (i.e. standard deviation of NN [SDNN], ratio of low frequency to high frequency power [LF/HF], detrended fluctuation analysis α-2 [DFA α-2]) in addition to the qSOFA score. The predictive accuracy was assessed with other scoring systems (i.e. qSOFA alone, National Early Warning Score, and Modified Early Warning Score) using the area under the receiver operating characteristic curve.ResultsA total of 343 septic patients were included. Non-survivors were significantly older (survivors vs. non-survivors, 65.7 vs. 72.9, p <0.01) and had higher qSOFA (0.8 vs. 1.4, p <0.01) as compared to survivors. There were significant differences in HRV variables between survivors and non-survivors including SDNN (23.7s vs. 31.8s, p = 0.02), LF/HF (2.8 vs. 1.5, p = 0.02), DFA α-2 (1.0 vs. 0.7, P < 0.01). Our prediction model using DFA-α-2 had the highest c-statistic of 0.76 (95% CI, 0.70 to 0.82), followed by qSOFA of 0.68 (95% CI, 0.62 to 0.75), National Early Warning Score at 0.67 (95% CI, 0.61 to 0.74), and Modified Early Warning Score at 0.59 (95% CI, 0.53 to 0.67).ConclusionsAdding DFA-α-2 to the qSOFA score may improve the accuracy of predicting in-hospital mortality in septic patients who present to the ED. Further multicenter prospective studies are required to confirm our results.

show abstract

Section: Discussionmentioning

confidence: 99%

Combining quick sequential organ failure assessment score with heart rate variability may improve predictive ability for mortality in septic patients at the emergency department

et al. 2019

View full text Add to dashboard Cite

show abstract

“…There are several non-invasive methods to assess heart function following sepsis including functional (Echocardiography; Echo-Doppler), electrical (electrocardiograms; ECGs) measurements and biomarkers present in the plasma. These techniques are still commonly used in septic patients in the hospital to assess cardiac function and monitor the hemodynamic condition (Barnaby, et al 2018; Beraud, et al 2014; Guerin and Vieillard-Baron 2016; Haileselassie, et al 2016; Ozdemir, et al 2016; Quinten, et al 2017; S, et al 2014; Shashikumar, et al 2017).…”

Section: Methods To Assess Heart Function In Sepsismentioning

confidence: 99%

Role of complement C5a and histones in septic cardiomyopathy

Fattahi

Frydrych

Bian

et al. 2018

Molecular Immunology

View full text Add to dashboard Cite

Polymicrobial sepsis (after cecal ligation and puncture, CLP) causes robust complement activation with release of C5a. Many adverse events develop thereafter and will be discussed in this review article. Activation of complement system results in generation of C5a which interacts with its receptors (C5aR1, C5aR2). This leads to a series of harmful events, some of which are connected to the cardiomyopathy of sepsis, resulting in defective action potentials in cardiomyocytes (CMs), activation of the NLRP3 inflammasome in CMs and the appearance of extracellular histones, likely arising from activated neutrophils which form neutrophil extracellular traps (NETs). These events are associated with activation of mitogen-activated protein kinases (MAPKs) in CMs. The ensuing release of histones results in defective action potentials in CMs and reduced levels of [Ca]i-regulatory enzymes including sarco/endoplasmic reticulum Ca-ATPase (SERCA2) and Na/Ca exchanger (NCX) as well as Na/K-ATPase in CMs. There is also evidence that CLP causes release of IL-1β via activation of the NLRP3 inflammasome in CMs of septic hearts or in CMs incubated in vitro with C5a. Many of these events occur after in vivo or in vitro contact of CMs with histones. Together, these data emphasize the role of complement (C5a) and C5a receptors (C5aR1, C5aR2), as well as extracellular histones in events that lead to cardiac dysfunction of sepsis (septic cardiomyopathy).

show abstract

“…Reduced RMSSD has also been shown to predict for 28-day mortality in septic patients presenting at the ED (45). Some prior studies demonstrated that a decreased LF/HF ratio of less than 1.0 may predict severity of illness in septic patients (46,47). When integrated with various components of other warning scores, HRV parameters have been found to be superior in risk-stratifying septic patients at the ED (48).…”

Section: Adult Sepsismentioning

confidence: 99%

A narrative review of heart rate and variability in sepsis

Wee¹,

Lee²,

Mok³

et al. 2020

Ann Transl Med

View full text Add to dashboard Cite

Clinicians face challenges in the timely diagnosis and management of pediatric sepsis. Pediatric heart rate has been incorporated into early warning systems and studied as a predictor for critical illness. We aim to review: (I) the role of heart rate in pediatric warning systems and (II) the role of heart rate variability (HRV) in adult and neonatal sepsis, with a focus on its potential applications in pediatrics. We conducted a literature search for papers published up to December 2019 on the utility of heart rate and HRV analysis in the diagnosis and management of sepsis, using four medical databases: PubMed, Google Scholar, EMBASE and Web of Science. This review demonstrates that the clinical utility of pediatric heart rate in predicting clinical deterioration is limited by the lack of consensus among warning systems, consensus-based guidelines, and evidence-based studies as to what constitutes abnormal heart rate in the pediatric age group. Current studies demonstrate that abnormal heart rate itself does not adequately discriminate children with sepsis from those without. HRV analysis provides a quick and non-invasive method of assessment and can provide more information than traditional heart rate. HRV analysis has the potential to add value in identification and prognostication of adult and neonatal sepsis. With further studies to explore its role, HRV analysis has the potential to add to current tools in the diagnosis and prognosis of pediatric sepsis.

show abstract

Use of the low-frequency/high-frequency ratio of heart rate variability to predict short-term deterioration in emergency department patients with sepsis

Abstract: While we found a statistically significant relationship between HRV, SOFA and HRV+SOFA, and early deterioration, none reliably functioned as a clinical predictive tool. More complex multivariable models will likely be required to construct models with clinical utility.

Cited by 15 publications

References 45 publications

Combining quick sequential organ failure assessment score with heart rate variability may improve predictive ability for mortality in septic patients at the emergency department

Combining quick sequential organ failure assessment score with heart rate variability may improve predictive ability for mortality in septic patients at the emergency department

Role of complement C5a and histones in septic cardiomyopathy

A narrative review of heart rate and variability in sepsis

Contact Info

Product

Resources

About