Heart rate variability as predictor of mortality in sepsis: A systematic review

Abstract

BackgroundAutonomic dysregulation is one of the recognized pathophysiological mechanisms in sepsis, generating the hypothesis that heart rate variability (HRV) can be used to predict mortality in sepsis.MethodsThis was a systematic review of studies evaluating HRV as a predictor of death in patients with sepsis. The search was performed by independent researchers in PubMed, LILACS and Cochrane, including papers in English, Portuguese or Spanish, indexed until August 20th, 2017 with at least 10 patients. Study quality was assessed by Newcastle-Ottawa Scale. To analyze the results, we divided the articles between those who measured HRV for short-term recordings (≤ 1 hour), and those who did long-term recordings (≥ 24 hours).ResultsNine studies were included with a total of 536 patients. All of them were observational studies. Studies quality varied from 4 to 7 stars in Newcastle-Ottawa Scale. The mortality rate in the studies ranged from 8 to 61%. Seven studies performed HRV analysis in short-term recordings. With the exception of one study that did not explain which group had the lowest results, all other studies showed reduction of several HRV parameters in the non-survivors in relation to the surviving septic patients. SDNN (Standard deviation of the Normal to Normal interval), TP (Total Power), VLF (Very Low Frequency Power), LF (Low Frequency Power), LF/HF (Low Frequency Power / High Frequency Power), nLF (Normalized Low Frequency Power), α1/α2 (short-term and long-term fractal scaling coefficients from DFA) and r-MSSD (Square root of the squared mean of the difference of successive NN-intervals) of the non-survivor group were reduced in relation to the survivors in at least one study. Two studies found that SDNN is associated with mortality in sepsis, even after adjusting for possible confounding factors. Three studies performed HRV analysis using long-term recordings. Only one of these studies found difference between surviving and non-surviving groups, and even so, in only one HRV parameter: LogHF.ConclusionsSeveral HRV parameters are reduced in nonsurviving septic patients in short-term recording. Two studies have found that SDNN is associated with mortality in sepsis, even after adjusting for possible confounding factors.

Heart rate variability as an independent predictor for 8-year mortality among chronic hemodialysis patients

“…Hypoalbuminemia and old age were well-known risk factors for poor outcomes and were published previously 15 . As to the association between HRV indices and infection-associated mortality, a systematic review disclosed that low values of several HRV indices, including variance, TP, VLF, LF, LF/HF ratio, and nLF could predict mortality in sepsis patients 34 .…”

“…This effect of nHF on infection-associated mortality had not been summarized in the recent systemic review 34 . Although some studies suggested that vagal activities might be beneficial in sepsis 35,36 , other investigations reported that the HF was significantly higher in the nonsurvivors than in the survivors among septic patients 37,38 .…”

Heart Rhythm Complexity as Predictors for the Prognosis of End-Stage Renal Disease Patients Undergoing Hemodialysis

“…Furthermore, low HRV is associated with mortality in various diseases [27][28][29][30] . In the present study, we found that all of the analyzed traditional HRV parameters, as well as conventional non-linear measures and CI, were significantly different between the ESRD and healthy control groups except for the Mean RR.…”

A Personalized Signature and Chronotherapy-Based Platform for Improving the Efficacy of Sepsis Treatment

“…Changes in HRV maybe associated with impending septic shock and increased mortality in sepsis patients (Chen and Kuo, 2007;de Castilho et al, 2018). A systemic review of clinical studies suggested a reduction in HRV parameters in non-surviving sepsis patients (de Castilho et al, 2018).…”

“…Changes in HRV maybe associated with impending septic shock and increased mortality in sepsis patients (Chen and Kuo, 2007;de Castilho et al, 2018). A systemic review of clinical studies suggested a reduction in HRV parameters in non-surviving sepsis patients (de Castilho et al, 2018). In one study, after adjusting for SOFA and acute physiology and chronic health evaluation II (APACHE II) scores, an SDNN of ≤17 ms was associated with a hazard ratio of 6.3 for increased mortality (de Castilho et al, 2017).…”