Depressed sympathovagal modulation indicates sepsis in patients with suspected infection

Abstract

This study explored whether sympathovagal modulation assessed through frequency domains of heart rate variability (HRV) can indicate sepsis in patients with suspected infection. In total, 370 consecutive adult patients with suspected infection admitted to the emergency department were enrolled in this single-center cohort study. A continuous 10-minute electrocardiography for HRV analysis was recorded immediately for these patients after inclusion. Patients were stratified into non-sepsis and sepsis groups based on a sepsis-related organ failure assessment score of ≥2 that met the Third International Consensus Definitions for Sepsis. Seven frequency domains of HRV were compared between these 2 groups. Compared with the non-sepsis group (n = 98), the sepsis group (n = 272) had a significantly lower incidence of respiratory tract infection, higher total power, higher very-low-frequency component, higher high-frequency (HF) component, higher normalized HF component, lower normalized low-frequency (LF) component, and lower LF component/HF component ratio (LF/HF). Multiple logistic regression model identified HF component (odds ratio [OR] = 0.994; 95% confidence interval [CI], 0.990–0.999) and LF/HF (OR = 0.494; 95% CI, 0.423–0.578) as significant variables associated with sepsis. The area under receiver operating characteristic curves of HF component and LF/HF was 0.741 (95% CI, 0.685–0.797) and 0.930 (95% CI, 0.900–0.960), respectively, in identifying sepsis in patients with suspected infection. Tilted sympathovagal balance toward increased vagal activity and depressed sympathetic modulation, assessed by the HF component and LF/HF, may indicate sepsis in patients with suspected infection.

Is the use of RAS inhibitors safe in the current era of COVID-19 pandemic?

“…In a recent retrospective population based cohort study, Hsu W, et al, reported that established RAS blockade therapy before sepsis will be protective for the sepsis related mortality [1]. These results seems to be in line with the recent study showing depressed sympathetic modulation can be a signal for sepsis in patient with infection [2]. Some mediators to suppress sympathetic nervous system may be required for sustained hypotension so that those mediators may not be effective if additional blocking is not possible due to already established sympathetic blockade.…”

Suppression by central adenosine A3 receptors of the cholinergic defense against cardiovascular aberrations of sepsis: role of PI3K/MAPKs/NFκB signaling

“…This gains support from the observations that CLP rats exhibited (i) diminished overall cardiac autonomic control as indexed by the falls in SDNN and total power, and (ii) shifts in sympathovagal balance towards parasympathetic predominance as verified by the reductions in LF/HF ratios. The increased vagal activity and depressed sympathetic modulation of the heart have been reported in septic patients (Hsu et al, 2020). Clinically, the depressed HRV in septic patients correlates with worsened prognosis and mortality in sepsis (Barnaby et al, 2002;Pontet et al, 2003;de Castilho et al, 2018).…”

Potential Neuroprotective Role of Melatonin in Sepsis-Associated Encephalopathy Due to Its Scavenging and Anti-Oxidative Properties

“…This potential to modulate the activity of the autonomic nervous system was elegantly shown in patients who underwent pinealectomy—a therapy with exogenic melatonin restored the sympathetic–parasympathetic balance in these subjects [ 75 ]. This ability to harmonize both parts of the autonomic nervous system may be especially important in septic patients, in which the disruption of sympathovagal modulation may even precede the development of a systemic inflammatory response [ 76 ]. It can be speculated that the use of melatonin may be parallel to the stimulation of the vagal nerve, as successfully implemented in animal models of sepsis [ 77 ].…”