Heart Rate Variability Measures for Prediction of Severity of Illness and Poor Outcome in ED Patients with Sepsis

Overview

Journal Am J Emerg Med

Specialty Emergency Medicine

Date 2020 Jan 27

PMID 31982224

Citations 12

Authors

John E Arbo

Jeremy K Lessing

William J H Ford

Sunday Clark

Eli Finkelsztein

Edward J Schenck

Rahul Sharma

Paul M Heerdt

Affiliations

Soon will be listed here.

Abstract

Introduction: This study evaluates the utility of heart rate variability (HRV) for assessment of severity of illness and poor outcome in Emergency Department (ED) patients with sepsis. HRV measures evaluated included low frequency (LF) signal, high frequency (HF) signal, and deviations in LF and HF signal from age-adjusted reference values.

Methods: This was a prospective, observational study. Seventy-two adult ED patients were assessed within 6 h of arrival.

Results: Severity of illness as defined by sepsis subtype correlated with decreased LF signal (sepsis: 70.68 ± 22.95, severe sepsis: 54.00 ± 28.41, septic shock: 45.54 ± 23.31, p = 0.02), increased HF signal (sepsis: 27.87 ± 19.42, severe sepsis: 44.63 ± 27.29, septic shock: 47.66 ± 20.98, p = 0.01), increasingly negative deviations in LF signal (sepsis: 0.41 ± 24.53, severe sepsis: -21.43 ± 30.09, septic shock -30.39 ± 26.09, p = 0.005) and increasingly positive deviations in HF signal (sepsis: -1.86 ± 21.09, severe sepsis: 20.07 ± 29.03, septic shock: 23.6 ± 24.17, p = 0.004). Composite poor outcome correlated with decreased LF signal (p = 0.008), increased HF signal (p = 0.03), large negative deviations in LF signal (p = 0.004) and large positive deviations in HF signal (p = 0.02). Deviations in LF and HF signal from age-adjusted reference values correlated with individual measures of poor outcome with greater consistency than LF or HF signal.

Discussion: Accounting for the influence of age on baseline HRV signal improves the predictive value of HRV measures in ED patients with sepsis.

Citing Articles

Development of Prediction Model for Intensive Care Unit Admission Based on Heart Rate Variability: A Case-Control Matched Analysis.

Choi D, Lee H, Joo H, Kong H, Lee S, Kim S Diagnostics (Basel). 2024; 14(8).

PMID: 38667462 PMC: 11049103. DOI: 10.3390/diagnostics14080816.

COVID-19 surveillance based on consumer wearable devices.

Sun A, Liao J, Zhang C, Yu K, Ma X, Wang G Digit Health. 2024; 10:20552076241247374.

PMID: 38665889 PMC: 11044784. DOI: 10.1177/20552076241247374.

Influence of blood lactate variations and passive exercise on cardiac responses.

Fujita D, Kubo Y J Phys Ther Sci. 2024; 36(2):69-73.

PMID: 38304152 PMC: 10830155. DOI: 10.1589/jpts.36.69.

Real-time machine learning model to predict in-hospital cardiac arrest using heart rate variability in ICU.

Lee H, Yang H, Ryu H, Jung C, Cho Y, Yoon S NPJ Digit Med. 2023; 6(1):215.

PMID: 37993540 PMC: 10665411. DOI: 10.1038/s41746-023-00960-2.

HIRA: Heart Rate Interval based Rapid Alert score to characterize autonomic dysfunction among patients with sepsis-related acute respiratory failure (ARF).

Krishnan P, Rad M, Agarwal P, Marshall C, Yang P, Bhavani S Physiol Meas. 2023; 44(10).

PMID: 37652033 PMC: 10571460. DOI: 10.1088/1361-6579/acf5c7.

References

Papaioannou V, Pneumatikos I, Maglaveras N . Association of heart rate variability and inflammatory response in patients with cardiovascular diseases: current strengths and limitations. Front Physiol. 2013; 4:174. PMC: 3706751. DOI: 10.3389/fphys.2013.00174. View

Barnaby D, Ferrick K, Kaplan D, Shah S, Bijur P, Gallagher E . Heart rate variability in emergency department patients with sepsis. Acad Emerg Med. 2002; 9(7):661-70. DOI: 10.1111/j.1553-2712.2002.tb02143.x. View

Angus D, Lidicker J, Clermont G, Carcillo J, Pinsky M . Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001; 29(7):1303-10. DOI: 10.1097/00003246-200107000-00002. View

Billman G . Heart rate variability - a historical perspective. Front Physiol. 2011; 2:86. PMC: 3225923. DOI: 10.3389/fphys.2011.00086. View

. Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J. 1996; 17(3):354-81. View

Ahmad S, Tejuja A, Newman K, Zarychanski R, Seely A . Clinical review: a review and analysis of heart rate variability and the diagnosis and prognosis of infection. Crit Care. 2009; 13(6):232. PMC: 2811891. DOI: 10.1186/cc8132. View

Abhishekh H, Nisarga P, Kisan R, Meghana A, Chandran S, Trichur Raju . Influence of age and gender on autonomic regulation of heart. J Clin Monit Comput. 2013; 27(3):259-64. DOI: 10.1007/s10877-012-9424-3. View

Winchell R, Hoyt D . Spectral analysis of heart rate variability in the ICU: a measure of autonomic function. J Surg Res. 1996; 63(1):11-6. DOI: 10.1006/jsre.1996.0214. View

Chen W, Kuo C . Characteristics of heart rate variability can predict impending septic shock in emergency department patients with sepsis. Acad Emerg Med. 2007; 14(5):392-7. DOI: 10.1197/j.aem.2006.12.015. View

10.

Kumar A, Roberts D, Wood K, Light B, Parrillo J, Sharma S . Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006; 34(6):1589-96. DOI: 10.1097/01.CCM.0000217961.75225.E9. View

11.

Rhodes A, Evans L, Alhazzani W, Levy M, Antonelli M, Ferrer R . Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med. 2017; 43(3):304-377. DOI: 10.1007/s00134-017-4683-6. View

12.

Ahmad S, Ramsay T, Huebsch L, Flanagan S, McDiarmid S, Batkin I . Continuous multi-parameter heart rate variability analysis heralds onset of sepsis in adults. PLoS One. 2009; 4(8):e6642. PMC: 2721415. DOI: 10.1371/journal.pone.0006642. View

13.

Harris P, Taylor R, Thielke R, Payne J, Gonzalez N, Conde J . Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2008; 42(2):377-81. PMC: 2700030. DOI: 10.1016/j.jbi.2008.08.010. View

14.

Dombrovskiy V, Martin A, Sunderram J, Paz H . Rapid increase in hospitalization and mortality rates for severe sepsis in the United States: a trend analysis from 1993 to 2003. Crit Care Med. 2007; 35(5):1244-50. DOI: 10.1097/01.CCM.0000261890.41311.E9. View

15.

Pontet J, Contreras P, Curbelo A, Medina J, Noveri S, Bentancourt S . Heart rate variability as early marker of multiple organ dysfunction syndrome in septic patients. J Crit Care. 2003; 18(3):156-63. DOI: 10.1016/j.jcrc.2003.08.005. View

16.

Seely A, Christou N . Multiple organ dysfunction syndrome: exploring the paradigm of complex nonlinear systems. Crit Care Med. 2000; 28(7):2193-200. DOI: 10.1097/00003246-200007000-00003. View

17.

Gunther A, Salzmann I, Nowack S, Schwab M, Surber R, Hoyer H . Heart rate variability - a potential early marker of sub-acute post-stroke infections. Acta Neurol Scand. 2011; 126(3):189-96. DOI: 10.1111/j.1600-0404.2011.01626.x. View

18.

Bravi A, Green G, Longtin A, Seely A . Monitoring and identification of sepsis development through a composite measure of heart rate variability. PLoS One. 2012; 7(9):e45666. PMC: 3446945. DOI: 10.1371/journal.pone.0045666. View

19.

Norris P, Ozdas A, Cao H, Williams A, Harrell F, Jenkins J . Cardiac uncoupling and heart rate variability stratify ICU patients by mortality: a study of 2088 trauma patients. Ann Surg. 2006; 243(6):804-12. PMC: 1570581. DOI: 10.1097/01.sla.0000219642.92637.fd. View

20.

Kochanek K, Murphy S, Xu J, Tejada-Vera B . Deaths: Final Data for 2014. Natl Vital Stat Rep. 2016; 65(4):1-122. View