Estudio ECAIS: eventos cardiovasculares adversos inadvertidos en sepsis

Duque, M. Gómez; Olivera, C. Enciso; Torres, E. Peña; Duran, O.; Estrada, Veronica

doi:10.1016/j.medin.2011.11.008

Cited by 12 publications

(11 citation statements)

References 42 publications

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“…Unlike the study by Duke et al[13], in ours, HRV parameters were significantly different between survivors and nonsurvivors only in the 20-minute Holter. Holter with shorter periods of record is potentially more useful for be used in critical care patients, including those with sepsis, because these patients present immediate risk of death and therefore need a fast tool for definition of severity.…”

Section: Discussioncontrasting

confidence: 99%

“…Global HRV parameters such as SDNN and TP were lower in nonsurviving patients of this study, which is consistent with the findings of previous studies[12, 13]. Chen et al[12] had demonstrated that SDNN would be a significant independent variable in the prediction of in-hospital mortality for emergency department patients with sepsis, although these authors did not present cut-off point for this HRV parameter.…”

Section: Discussionsupporting

confidence: 91%

“…Furthermore, HRV parameters such as low frequency (LF) power are positively correlated with APACHE II and SOFA[10] and negatively correlated with interleukins[11]. Small studies have suggested that sepsis survivors present HRV parameters (e.g., standard deviation of NN interval, SDNN) higher than nonsurvivors[12, 13]. However, no study has defined a specific HRV parameter and a cut-off point that can be used in practice for the prediction of the risk of death in septic patients.…”

Section: Introductionmentioning

confidence: 99%

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Heart rate variability as predictor of mortality in sepsis: A prospective cohort study

et al. 2017

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BackgroundSepsis is a serious medical condition with increasing prevalence and high mortality. The role of the autonomic nervous system in pathophysiology of sepsis has been increasingly researched. The objective of this study is to evaluate the Heart rate variability (HRV) as a predictor of mortality in septic patients.MethodsThis was a prospective cohort of patients diagnosed with sepsis. Patient recruitment was carried out at ICU in tertiary university hospital between March 2012 and February 2014. Clinical data and laboratory exams were collected at admission. Each patient underwent a 20-minute Holter and a 24-hour Holter on the first day of enrollment. The primary outcome was the 28-day all-cause mortality.ResultsA total of 63 patients were included. Patients were categorized into nonsurvivor group (n = 16) or survivor group (n = 47) depending on this endpoint. Survivors were younger (48.6 years vs. 63.0 years), had better renal function and lower values in severity scores (APACHE II and SOFA) compared to nonsurvivors. In the 20-minute Holter, SDNN, Total Power, VLF Power, LF Power and LF/HF of nonsurvivors were significantly lower than those of survivors (p = <0.001, p = 0.003, p = 0.002, p = 0.006, p = 0.009 respectively). ROC curve of SDNN was built, showing area under the curve of 0.772 (0.638–0.906) for mortality. The value of 17ms was chosen as best SDNN cutoff to discriminate survivors and nonsurvivors. In the Cox proportional regression, adjusted for SOFA score and for APACHE II, a SDNN ≤ 17ms was associated with a greater risk of death, with hazard ratios of 6.3 (1.4–28.0; p = 0.015) and 5.5 (1,2–24,8; p = 0.027), respectively. The addition of the dichotomized SDNN to the SOFA model reduced AIC and increased the concordance statistic and the R2, indicating that predictive power of the SDNN + SOFA model is better than predictive power of SOFA only.ConclusionsSeveral HRV parameters are reduced in nonsurviving septic patients. SDNN ≤17 is a risk factor for death in septic patients, even after adjusting for severity scores.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

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Heart rate variability as predictor of mortality in sepsis: A prospective cohort study

et al. 2017

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“… 18/61 Prospective bedside detection +12-lead confirmation n/a Moderate Christian et al ., 2008 [ 17 ] Single center, mixed ICU, USA. 274/274 Retrospective review of monitor data from a database developed for benchmarking Death Moderate Gomez et al ., 2012 [ 18 ] Multicenter, mixed ICUs, Columbia. 100/100 Prospective detection using telemetry n/a Low Goodman et al ., 2007 [ 19 ] Single center, mixed ICU, Israel.…”

Section: Resultsmentioning

confidence: 99%

“…Furthermore, the reported incidences in our review varied widely between studies, which may be explained by random variation due to the small sample sizes of most included studies, but also by differences in patient populations and by misclassification (that is, not all episodes of AF may have been correctly detected). In fact, the domain was not clearly defined in five studies, and some did not explicitly exclude patients who developed sepsis following cardiac surgery [ 18 , 22 - 24 , 26 ]. In addition, another seven studies did not explicitly exclude patients with a prior history of chronic or paroxysmal AF [ 16 , 18 , 21 - 24 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

Incidence, risk factors and outcomes of new-onset atrial fibrillation in patients with sepsis: a systematic review

2014

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IntroductionCritically ill patients with sepsis are prone to develop cardiac dysrhythmias, most commonly atrial fibrillation (AF). Systemic inflammation, circulating stress hormones, autonomic dysfunction, and volume shifts are all possible triggers for AF in this setting. We conducted a systematic review to describe the incidence, risk factors and outcomes of new-onset AF in patients with sepsis.MethodsMEDLINE, EMBASE and Web Of Science were searched for studies reporting the incidence of new-onset AF, atrial flutter or supraventricular tachycardia in patients with sepsis admitted to an intensive care unit, excluding studies that primarily focused on postcardiotomy patients. Studies were assessed for methodological quality using the GRADE system. Risk factors were considered to have a high level of evidence if they were reported in ≥2 studies using multivariable analyses at a P value <0.05. Subsequently, the strength of association was classified as strong, moderate or weak, based on the reported odds ratios.ResultsEleven studies were included. Overall quality was low to moderate. The weighted mean incidence of new-onset AF was 8% (range 0 to 14%), 10% (4 to 23%) and 23% (6 to 46%) in critically ill patients with sepsis, severe sepsis and septic shock, respectively. Independent risk factors with a high level of evidence included advanced age (weak strength of association), white race (moderate association), presence of a respiratory tract infection (weak association), organ failure (moderate association), and pulmonary artery catheter use (moderate association). Protective factors were a history of diabetes mellitus (weak association) and the presence of a urinary tract infection (weak association). New-onset AF was associated with increased short-term mortality in five studies (crude relative effect estimates ranging from 1.96 to 3.32; adjusted effects 1.07 to 3.28). Three studies reported a significantly increased length of stay in the ICU (weighted mean difference 9 days, range 5 to 13 days), whereas an increased risk of ischemic stroke was reported in the single study that looked at this outcome.ConclusionsNew-onset AF is a common consequence of sepsis and is independently associated with poor outcome. Early risk stratification of patients may allow for pharmacological interventions to prevent this complication.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-014-0688-5) contains supplementary material, which is available to authorized users.

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Correlation between heart rate variability and cerebral autoregulation in septic patients

Cornejo

Crippa

Bakos

et al. 2023

Autonomic Neuroscience

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Estudio ECAIS: eventos cardiovasculares adversos inadvertidos en sepsis

Cited by 12 publications

References 42 publications

Heart rate variability as predictor of mortality in sepsis: A prospective cohort study

Heart rate variability as predictor of mortality in sepsis: A prospective cohort study

Incidence, risk factors and outcomes of new-onset atrial fibrillation in patients with sepsis: a systematic review

Correlation between heart rate variability and cerebral autoregulation in septic patients

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