Noninvasive measurements of hemodynamic, autonomic and endothelial function as predictors of mortality in sepsis: A prospective cohort study

Bonjorno, José Carlos; Caruso, Flávia Cristina Rossi; Mendes, Renata Gonçalves; Silva, Tamara Rodrigues da; Biazon, Thaís Marina Pires de Campos; Rangel, Francini; Phillips, Shane A.; Arena, Ross; Borghi‐Silva, Audrey

doi:10.1371/journal.pone.0213239

Cited by 21 publications

(12 citation statements)

References 38 publications

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“…An increased square root of the mean of the sum of the squares of differences between adjacent NN intervals (RMSSD) was found in patients who developed septic shock within 6 hours of presentation at the ED (44). Reduced RMSSD has also been shown to predict for 28-day mortality in septic patients presenting at the ED (45). Some prior studies demonstrated that a decreased LF/HF ratio of less than 1.0 may predict severity of illness in septic patients (46,47).…”

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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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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“…In this study, we could not show the relationship between HRV parameters and the mortality or severity of sepsis compared with previous studies. 5 , 6 , 7 The limitations to the HRV interpretation as a representative of autonomic regulation in sepsis are considered. First, invasive procedures influence HRV.…”

Section: Discussionmentioning

confidence: 99%

“…S1 ). However, previous studies on HRV with the prediction outcome of sepsis are conflicting 5 , 6 , 7 because (i) the specific clinical features reflected by HRV were unclear (e.g., inflammation, hypoperfusion, and organ dysfunction), and (ii) prior studies included the possibility of modifying the invasive procedure influencing HRV. We believe that clarifying the connection between autonomic regulation and pathophysiology in sepsis offers noninvasive and quick measurements of sepsis.…”

Section: Introductionmentioning

confidence: 99%

Exploration of autonomic regulation reflecting on pathophysiological change of sepsis: a prospective observational study

Nakashima

Inagaki

Kasaoka

2022

Acute Medicine & Surgery

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Aim It remains unclear how autonomic regulation modulates pathophysiological changes of sepsis. This study aims to analyze and clarify those in patients with suspected sepsis. Methods In this single‐centered, prospective, observational study, adult patients who had an infection, a quick Sequential Organ Failure Assessment score of 2 or more at the emergency department, and underwent intensive care were screened. Heart rate variability (HRV) and serum adrenaline were measured immediately after arrival. The primary outcome was defined as vasopressor dependence during 48 h after arrival. Results A total of 63 patients were included. All the patients had SOFA score of 2 or more on admission. Vasopressor dependence, renal replacement therapy, and in‐hospital mortality were associated with higher adrenaline (which reflects sympathetic adrenergic system activity). Bacteremia was associated with lower high‐frequency components of HRV (parasympathetic nerve activity). The HRV parameter of sympathetic nerve activity had no significant association with the outcomes. In the multivariate logistic regression model adjusted for age and sex, vasopressor dependence remained associated with higher adrenaline (cut‐off 0.11 ng/mL, odds ratio 9.71, 95% confidence interval 2.55–37; P = 0.000874), and lower high‐frequency components with bacteremia (17.2 ms 2 , odds ratio 4.86, 95% confidence interval 1.36–17.4; P = 0.0152). There were no significant correlations between parameters of HRV and serum adrenaline. Conclusion Hypoperfusion, organ dysfunction, and in‐hospital mortality were associated with an increased sympathetic adrenergic activity. Bacteremia was associated with decreased parasympathetic nerve activity. The autonomic regulator may involve a multilayered and differentiated modulating process for sepsis.

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“…In non-septic patients, Bergström et al found RH-PAT to decrease from admission to day 3 after subarachnoid haemorrhage and identified a significant correlation with mortality [ 26 ]. Furthermore, other methods of accessing reactive hyperaemia such as FMD and peak hyperaemic flow velocity in the brachial artery found promising results regarding the association with mortality in the septic and non-septic critically ill patients admitted to the ICU [ 27 – 29 ].…”

Section: Discussionmentioning

confidence: 99%

Peripheral arterial tonometry as a method of measuring reactive hyperaemia correlates with organ dysfunction and prognosis in the critically ill patient: a prospective observational study

Malheiro

Gaio

Silva

et al. 2020

J Clin Monit Comput

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Predictions of mortality may help in the selection of patients who benefit from intensive care. Endothelial dysfunction is partially responsible for many of the organic dysfunctions in critical illness. Reactive hyperaemia is a vascular response of the endothelium that can be measured by peripheral arterial tonometry (RH-PAT). We aimed to assess if reactive hyperaemia is affected by critical illness and if it correlates with outcomes. Prospective study with a cohort of consecutive patients admitted to an Intensive Care Unit. RH-PAT was accessed on admission and on the 7th day after admission. Early and late survivors were compared to non-survivors. The effect of RH-PAT variation on late mortality was studied by a logistic regression model. The association between RH-PAT and severity scores and biomarkers of organic dysfunction was investigated by multivariate analysis. 86 patients were enrolled. Mean ln(RHI) on admission was 0.580 and was significantly lower in patients with higher severity scores (p < 0.01) and early non-survivors (0.388; p = 0.027). The model for prediction of early-mortality estimated that each 0.1 decrease in ln(RHI) increased the odds for mortality by 13%. In 39 patients, a 2nd RH-PAT measurement was performed on the 7th day. The variation of ln(RHI) was significantly different between non-survivors and survivors (− 24.2% vs. 63.9%, p = 0.026). Ln(RHI) was significantly lower in patients with renal and cardiovascular dysfunction (p < 0.01). RH-PAT is correlated with disease severity and seems to be an independent marker of early mortality, cardiovascular and renal dysfunctions. RH-PAT variation predicts late mortality. There appears to be an RH-PAT impairment in the acute phase of severe diseases that may be reversible and associated with better outcomes.

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Noninvasive measurements of hemodynamic, autonomic and endothelial function as predictors of mortality in sepsis: A prospective cohort study

Cited by 21 publications

References 38 publications

A narrative review of heart rate and variability in sepsis

A narrative review of heart rate and variability in sepsis

Exploration of autonomic regulation reflecting on pathophysiological change of sepsis: a prospective observational study

Peripheral arterial tonometry as a method of measuring reactive hyperaemia correlates with organ dysfunction and prognosis in the critically ill patient: a prospective observational study

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