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

Abstract

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.

Significant reduction in heart rate variability is a feature of acute decompensation of cirrhosis and predicts 90‐day mortality

“…This is notable given that 50% of our studied patients that died did so from infection, and also the relationship between low SDNN and the development of the inflammatory syndrome of ACLF. This is aligned with a study demonstrating that septic patients on the intensive care unit had an increased risk of death in lower SDNN ranges, even after adjusting for other organ failure severity scores 12. This is supported by the wider literature on HRV, where for example after unstable angina pectoris, high levels of CRP correlate inversely with loss of HRV 23.…”

“…This suggests a future potential for continuous monitoring whereby an increase in SDNN following intervention, might inform of favourable response to therapy, whilst conversely, failure to recover SDNN might indicate patients with a higher risk of death.A further interesting observation was that HRV as assessed by SDNN demonstrated a good inverse correlation with CRP values and also with WBC. Similarly, following traumatic brain injury, there is a reduction in HRV and this is associated with a change in immune responses,24,25 whilst in patients treated for sepsis, reduced SDNN has been linked to poor outcome 12. This is notable given that 50% of our studied patients that died did so from infection, and also the relationship between low SDNN and the development of the inflammatory syndrome of ACLF.…”

“…This is aligned with a study demonstrating that septic patients on the intensive care unit had an increased risk of death in lower SDNN ranges, even after adjusting for other organ failure severity scores. 12 The need for a larger validation cohort for the SDNN cut-off of 13.25 ms for 90-day mortality is one limitation of our study.…”

Heart rate variability parameters in children with ventricular preexcitation

“…The autonomic nervous system has a significant regulatory effect on heart function; in addition to heart rate, cardiac conduction properties, hemodynamics, the cellular properties of cardiac myocytes, and cardiac arrhythmogenesis are also affected by the autonomic nervous system . Distinct effects of autonomic activation have been discussed in various clinical situations and specific types of arrhythmias . Heart rate variability (HRV) analysis is among the noninvasive methods that can be used to assess cardiac autonomic activity…”

“…1 Distinct effects of autonomic activation have been discussed in various clinical situations and specific types of arrhythmias. [2][3][4][5][6][7][8][9] Heart rate variability (HRV) analysis is among the noninvasive methods that can be used to assess cardiac autonomic activity. 10 Sudden cardiac death may be the initial manifestation of ventricular preexcitation syndrome.…”