Development of a Heart Rate Variability Risk Score to Predict Organ Dysfunction and Death in Critically Ill Children

Badke, Colleen M.; Marsillio, Lauren; Carroll, Michael S.; Weese‐Mayer, Debra E.; Sanchez-Pinto, L. Nelson

doi:10.1097/pcc.0000000000002707

Cited by 16 publications

(17 citation statements)

References 37 publications

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“…HRVi is a continuous, non-invasive physiologic marker of ANS function and can be measured in virtually all critically ill patients with high-frequency data collected from the bedside monitor. HRV has been shown to be predictive of in-hospital mortality in adults with sepsis ( 25 ) and in critically ill children ( 11 ). Our data now suggest that it can also be used to predict re-hospitalization in pediatric septic shock survivors.…”

Section: Discussionmentioning

confidence: 99%

“…Continuous heart rate data from the entire PICU stay were extracted from bedside monitors using the BedMaster system (Hillrom, Jupiter, FL) and stored locally in an archiving system within hospital servers. HRV was estimated using the integer HRV (HRVi), which was calculated as the standard deviation of the heart rate sampled every 1 s over 5 consecutive minutes and normalized for age as previously described ( 11 ). A minimum of 50% of the heart rate samples in each 5-min interval were needed to be included in the analysis.…”

Section: Methodsmentioning

confidence: 99%

“…ANS dysfunction (ANSD) may occur during an imbalanced or maladaptive response to infection, and is often identified as excessive, uncontrolled, or prolonged sympathetic activation, or inappropriate regulation by the parasympathetic nervous system (14). Most of the evidence of ANSD in critical illness is based on measures of heart rate variability (HRV), a non-invasive, continuous physiologic marker of ANS function that is inversely correlated with organ dysfunction and mortality in both adult and pediatric patients (11,(15)(16)(17). The goal of this study was to assess whether HRV during an index admission for septic shock was associated with re-hospitalizations within a year in survivors.…”

Section: Introductionmentioning

confidence: 99%

“…Certain biomarkers (specifically, the PERSEVERE tool which includes C-C chemokine ligand 3 (CCL3), interleukin 8 (IL8), heat shock protein 70 kDa 1B, granzyme B, and matrix metallopeptidase 8) have also been shown to predict HRQL at 3 months ( 10 ). While measures of autonomic nervous system (ANS) function have been used to risk-stratify critically ill patients at risk of poor outcomes ( 11 , 12 ), it is unknown if these measures are associated with risk of readmission or lower HRQL in survivors.…”

Section: Introductionmentioning

confidence: 99%

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Autonomic Nervous System Dysfunction Is Associated With Re-hospitalization in Pediatric Septic Shock Survivors

et al. 2022

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Objective: Re-hospitalization after sepsis can lead to impaired quality of life. Predictors of re-hospitalization could help identify sepsis survivors who may benefit from targeted interventions. Our goal was to determine whether low heart rate variability (HRV), a measure of autonomic nervous system dysfunction, is associated with re-hospitalization in pediatric septic shock survivors.Materials and Methods: This was a retrospective, observational cohort study of patients admitted between 6/2012 and 10/2020 at a single institution. Patients admitted to the pediatric intensive care unit with septic shock who had continuous heart rate data available from the bedside monitors and survived their hospitalization were included. HRV was measured using age-normalized z-scores of the integer HRV (HRVi), which is the standard deviation of the heart rate sampled every 1 s over 5 consecutive minutes. The 24-h median HRVi was assessed on two different days: the last 24 h of PICU admission (“last HRVi”) and the 24-h period with the lowest median HRVi (“lowest HRVi”). The change between the lowest and last HRVi was termed “delta HRVi.” The primary outcome was re-hospitalization within 1 year of discharge, including both emergency department encounters and hospital readmission, with sensitivity analyses at 30 and 90 days. Kruskal-Wallis, logistic regression, and Poisson regression evaluated the association between HRVi and re-hospitalizations and adjusted for potential confounders.Results: Of the 463 patients who met inclusion criteria, 306 (66%) were re-hospitalized, including 270 readmissions (58%). The last HRVi was significantly lower among re-hospitalized patients compared to those who were not (p = 0.02). There was no difference in the lowest HRVi, but patients who were re-hospitalized showed a smaller recovery in their delta HRVi compared to those who were not re-hospitalized (p = 0.02). This association remained significant after adjusting for potential confounders. In the sensitivity analysis, a smaller recovery in delta HRVi was consistently associated with a higher likelihood of re-hospitalization.Conclusion: In pediatric septic shock survivors, a smaller recovery in HRV during the index admission is significantly associated with re-hospitalization. This continuous physiologic measure could potentially be used as a predictor of patients at risk for re-hospitalization and lower health-related quality of life.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Autonomic Nervous System Dysfunction Is Associated With Re-hospitalization in Pediatric Septic Shock Survivors

et al. 2022

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“…40 These new findings point clearly to a role for highly-comparative time series analysis to detect previously unthought-of ways to characterized the pathophysiological dynamics of neonatal illness. Future work will test these new candidate algorithms against existing ones of heart rate characteristics analysis, crosscorrelation of heart rate and oxygen saturation, 42,43 heart rate variability, 44 and others.…”

Section: Discussionmentioning

confidence: 99%

Discovery of signatures of fatal neonatal illness in vital signs using highly comparative time-series analysis

Niestroy

et al. 2021

Preprint

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Objective: Signatures of illness in vital signs of Neonatal Intensive Care Unit (NICU) patients can inform on future adverse events and outcomes. We implemented highly comparative time-series analysis to discover features and predictive analytics tools for all-cause mortality in the next 7 days, using the ubiquitous HR and SpO2 vital sign data from bedside monitors. Design: We populated a Time Series Commons with the complete HR and SpO2 data from all infants in the University of Virginia NICU from 2009 to 2019. We calculated the results of applying over 80 members of 11 mathematical families to random ten-minute segments of 0.5Hz data each day for each infant, with varying parameter sets, resulting in 4998 algorithmic operations on each infant. We used an unsupervised mutual information-based method to cluster the results, and we selected a single representative operation from each cluster. We used our FAIRSCAPE framework to compute a detailed provenance of all computations, and we constructed a complete software library with links to the analyzed data for reproducibility and reuse. We made multivariable logistic regression models using the lasso to assay the usefulness of the algorithms. Setting: Neonatal ICU. Patients: 5957 NICU infants, of whom 206 died. Measurements and main results: 3555 algorithmic operations returned usable results. Twenty representative operations, selected from each of 20 unsupervised clusters, held more than 81% of the information predicting death. A multivariable model had an AUC of 0.81 for predicting death in the next 7 days. In addition, five algorithms outperformed others: moving threshold, successive increases, surprise, and a random walk model. Conclusions: Highly comparative time-series analysis revealed new vital sign metrics to identify NICU patients at the highest risk of death in the next week. This approach can facilitate the discovery of signatures of impending, potentially actionable, clinical decompensation in monitored patients.

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Cerebral cortical-autonomic connectivity in newborns: a first step to determine the autonomic signatures with advancing age?

Weese‐Mayer

Gonik

2021

Clin Auton Res

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Development of a Heart Rate Variability Risk Score to Predict Organ Dysfunction and Death in Critically Ill Children

Cited by 16 publications

References 37 publications

Autonomic Nervous System Dysfunction Is Associated With Re-hospitalization in Pediatric Septic Shock Survivors

Autonomic Nervous System Dysfunction Is Associated With Re-hospitalization in Pediatric Septic Shock Survivors

Discovery of signatures of fatal neonatal illness in vital signs using highly comparative time-series analysis

Cerebral cortical-autonomic connectivity in newborns: a first step to determine the autonomic signatures with advancing age?

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