Heart rate variability measures for prediction of severity of illness and poor outcome in ED patients with sepsis

Arbo, John E.; Lessing, Jeremy K; Ford, William J H; Clark, Sunday; Finkelsztein, Eli J.; Schenck, Edward J.; Sharma, Rahul; Heerdt, Paul M.

doi:10.1016/j.ajem.2020.01.012

Cited by 19 publications

(14 citation statements)

References 21 publications

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“…Moreover, heart rate was not independently associated with mortality from sepsis in the study. Nonetheless, variability in heart rate was associated with mortality from sepsis in some studies previously reported [ 36 – 38 ]. Consequently, heart rate at admission was not incorporated in the prediction model for convenience of implementation and practical implications.…”

Section: Discussionmentioning

confidence: 95%

Development and validation of a score to predict mortality in ICU patients with sepsis: a multicenter retrospective study

et al. 2021

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Background Early and accurate identification of septic patients at high risk for ICU mortality can help clinicians make optimal clinical decisions and improve the patients’ outcomes. This study aimed to develop and validate (internally and externally) a mortality prediction score for sepsis following admission in the ICU. Methods We extracted data retrospectively regarding adult septic patients from one teaching hospital in Wenzhou, China and a large multi-center critical care database from the USA. Demographic data, vital signs, laboratory values, comorbidities, and clinical outcomes were collected. The primary outcome was ICU mortality. Through multivariable logistic regression, a mortality prediction score for sepsis was developed and validated. Results Four thousand two hundred and thirty six patients in the development cohort and 8359 patients in three validation cohorts. The Prediction of Sepsis Mortality in ICU (POSMI) score included age ≥ 50 years, temperature < 37 °C, Respiratory rate > 35 breaths/min, MAP ≤ 50 mmHg, SpO2 < 90%, albumin ≤ 2 g/dL, bilirubin ≥ 0.8 mg/dL, lactate ≥ 4.2 mmol/L, BUN ≥ 21 mg/dL, mechanical ventilation, hepatic failure and metastatic cancer. In addition, the area under the receiver operating characteristic curve (AUC) for the development cohort was 0.831 (95% CI, 0.813–0.850) while the AUCs ranged from 0.798 to 0.829 in the three validation cohorts. Moreover, the POSMI score had a higher AUC than both the SOFA and APACHE IV scores. Notably, the Hosmer–Lemeshow (H–L) goodness-of-fit test results and calibration curves suggested good calibration in the development and validation cohorts. Additionally, the POSMI score still exhibited excellent discrimination and calibration following sensitivity analysis. With regard to clinical usefulness, the decision curve analysis (DCA) of POSMI showed a higher net benefit than SOFA and APACHE IV in the development cohort. Conclusion POSMI was validated to be an effective tool for predicting mortality in ICU patients with sepsis.

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Section: Discussionmentioning

confidence: 95%

Development and validation of a score to predict mortality in ICU patients with sepsis: a multicenter retrospective study

et al. 2021

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“…Given current research efforts, scoring systems incorporating HRV parameters may outperform those with traditional heart rate alone (Table 2). Short-term HRV analysis is a potential game-changer in better diagnostic accuracy for adult sepsis in the ED and ICUs and should be integrated with other vital signs obtained at triage for better performance (55,56). HRV remains a promising research field and there are ongoing studies that evaluate its utility as part of scoring systems (57).…”

Section: Adult Sepsismentioning

confidence: 99%

A narrative review of heart rate and variability in sepsis

Wee¹,

Lee²,

Mok³

et al. 2020

Ann Transl Med

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Clinicians face challenges in the timely diagnosis and management of pediatric sepsis. Pediatric heart rate has been incorporated into early warning systems and studied as a predictor for critical illness. We aim to review: (I) the role of heart rate in pediatric warning systems and (II) the role of heart rate variability (HRV) in adult and neonatal sepsis, with a focus on its potential applications in pediatrics. We conducted a literature search for papers published up to December 2019 on the utility of heart rate and HRV analysis in the diagnosis and management of sepsis, using four medical databases: PubMed, Google Scholar, EMBASE and Web of Science. This review demonstrates that the clinical utility of pediatric heart rate in predicting clinical deterioration is limited by the lack of consensus among warning systems, consensus-based guidelines, and evidence-based studies as to what constitutes abnormal heart rate in the pediatric age group. Current studies demonstrate that abnormal heart rate itself does not adequately discriminate children with sepsis from those without. HRV analysis provides a quick and non-invasive method of assessment and can provide more information than traditional heart rate. HRV analysis has the potential to add value in identification and prognostication of adult and neonatal sepsis. With further studies to explore its role, HRV analysis has the potential to add to current tools in the diagnosis and prognosis of pediatric sepsis.

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“…An infection in participants with PPROM can be considered as a stressor. Continuous HRV monitoring has been shown to reduce the gap between the onset of sepsis and its clinical recognition, allowing clinicians to direct early intervention efforts in sepsis treatment [ 43 , 44 ]. According to our results, the continuous measurements of the heart rate and its variability therefore also have promising potential for the prediction of early intraamniotic infection when monitoring women with PPROM.…”

Section: Discussionmentioning

confidence: 99%

Wearable sensors for prediction of intraamniotic infection in women with preterm premature rupture of membranes: a prospective proof of principle study

Brun

Girsberger

Rothenbühler³

et al. 2022

Arch Gynecol Obstet

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Purpose To evaluate the use of wearable sensors for prediction of intraamniotic infection in pregnant women with PPROM. Materials and methods In a prospective proof of principle study, we included 50 patients diagnosed with PPROM at the University Hospital Zurich between November 2017 and May 2020. Patients were instructed to wear a bracelet during the night, which measures physiological parameters including wrist skin temperature, heart rate, heart rate variability, and breathing rate. A two-way repeated measures ANOVA was performed to evaluate the difference over time of both the wearable device measured parameters and standard clinical monitoring values, such as body temperature, pulse, leucocytes, and C-reactive protein, between women with and without intraamniotic infection. Results Altogether, 23 patients (46%) were diagnosed with intraamniotic infection. Regarding the physiological parameters measured with the bracelet, we observed a significant difference in breathing rate (19 vs 16 per min, P < .01) and heart rate (72 vs 67 beats per min, P = .03) in women with intraamniotic infection compared to those without during the 3 days prior to birth. In parallel to these changes standard clinical monitoring values were significantly different in the intraamniotic infection group compared to women without infection in the 3 days preceding birth. Conclusion Our results suggest that wearable sensors are a promising, noninvasive, patient friendly approach to support the early detection of intraamniotic infection in women with PPROM. However, confirmation of our findings in larger studies is required before implementing this technique in standard clinical management.

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Heart rate variability measures for prediction of severity of illness and poor outcome in ED patients with sepsis

Cited by 19 publications

References 21 publications

Development and validation of a score to predict mortality in ICU patients with sepsis: a multicenter retrospective study

Development and validation of a score to predict mortality in ICU patients with sepsis: a multicenter retrospective study

A narrative review of heart rate and variability in sepsis

Wearable sensors for prediction of intraamniotic infection in women with preterm premature rupture of membranes: a prospective proof of principle study

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