Heart rate variability measures as predictors of in-hospital mortality in ED patients with sepsis.

OBJECTIVE To determine the predictive capability of heart rate variability (HRV) measures of patients with sepsis in the ED for in-hospital death. METHODS This was a prospective, observational study. A consecutive cohort of patients visiting the ED of a university teaching hospital who met the criteria of sepsis over a 6-month period were enrolled in this study. General demographics, vital signs, laboratory data, and Mortality in Emergency Department Sepsis score were obtained in the ED; the in-patient medical record was reviewed; and a series of continuous 10-minute electrocardiographic signals were recorded for off-line HRV analysis to assess the in-hospital mortality of the patients. RESULTS One hundred thirty-two patients aged 27 to 86 years who met the inclusion criteria were enrolled. According to the in-hospital outcome, the patients were categorized into 2 groups: nonsurvivors (n = 10) and survivors (n = 122). The baseline HRV measures, including SDNN, TP, VLFP, LFP, and LFP/HFP ratio, of nonsurvivors were significantly lower, whereas the nHFP was significantly higher, than those of survivors. Multiple logistic regression model identified SDNN and nHFP as the significant independent variables in the prediction of in-hospital mortality for ED patients with sepsis. The receiver operating characteristic area for SDNN and nHFP in predicting the risk of death was 0.700 and 0.739, respectively. CONCLUSIONS Heart rate variability measures, especially the SDNN and nHFP, may be used as valuable predictors of in-hospital mortality in patients with sepsis attending the ED.

[1]  D Annane,et al.  Inappropriate sympathetic activation at onset of septic shock: a spectral analysis approach. , 1999, American journal of respiratory and critical care medicine.

[2]  W. R. Mccabe,et al.  Gram-negative bacteremia: IV. Re-evaluation of clinical features and treatment in 612 patients , 1980 .

[3]  D. Adam,et al.  Assessment of autonomic function in humans by heart rate spectral analysis. , 1985, The American journal of physiology.

[4]  A. Malliani,et al.  Heart rate variability. Standards of measurement, physiological interpretation, and clinical use , 1996 .

[5]  Eduardo R Migliaro,et al.  Heart rate variability as early marker of multiple organ dysfunction syndrome in septic patients. , 2003, Journal of critical care.

[6]  P. Peterson,et al.  Severe sepsis in the emergency department and its association with a complicated clinical course. , 1998, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[7]  B. Goldstein.  On the importance of sympathovagal balance. , 2001, Critical care medicine.

[8]  L. Lind,et al.  Rapid Emergency Medicine score: a new prognostic tool for in‐hospital mortality in nonsurgical emergency department patients , 2004, Journal of internal medicine.

[9]  Brahm Goldstein,et al.  Heart rate variability in critical illness and critical care , 2002, Current opinion in critical care.

[10]  G. Jackson,et al.  Gram-Negative Bacteremia. II. Clinical, Laboratory, and Therapeutic Observations. , 1962 .

[11]  Sachin Shah,et al.  Heart rate variability in emergency department patients with sepsis. , 2002, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[12]  J. Vincent,et al.  Has the mortality of septic shock changed with time. , 1998, Critical care medicine.

[13]  R. Dellinger,et al.  Cardiovascular management of septic shock. , 2003, Critical care medicine.

[14]  K. Tracey,et al.  Vagus nerve stimulation attenuates the systemic inflammatory response to endotoxin , 2000, Nature.

[15]  Urs E. Ruttimann,et al.  Decomplexification in critical illness and injury: Relationship between heart rate variability, severity of illness, and outcome , 1998, Critical care medicine.

[16]  H M Lo,et al.  Effect of different recumbent positions on spectral indices of autonomic modulation of the heart during the acute phase of myocardial infarction , 2000, Critical care medicine.

[17]  David W Bates,et al.  Mortality in Emergency Department Sepsis (MEDS) score: A prospectively derived and validated clinical prediction rule* , 2003, Critical care medicine.

[18]  D. Toweill,et al.  Linear and nonlinear dynamics and the pathophysiology of shock. , 1998, New horizons.

[19]  T B Kuo,et al.  Spectral analysis of systemic arterial pressure and heart rate signals as a prognostic tool for the prediction of patient outcome in the intensive care unit. , 1997, Critical care medicine.

[20]  D. Hoyt,et al.  Spectral analysis of heart rate variability in the ICU: a measure of autonomic function. , 1996, The Journal of surgical research.

[21]  T G Buchman,et al.  Experimental human endotoxemia increases cardiac regularity: results from a prospective, randomized, crossover trial. , 1996, Critical care medicine.

[22]  D Annane,et al.  Cardiac variability in critically ill adults: Influence of sepsis , 2001, Critical care medicine.

[23]  Alice L Givan,et al.  Decreased physiologic variability as a generalized response to human endotoxemia* , 2005, Critical care medicine.

[24]  M. Levy,et al.  2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference , 2003, Intensive care medicine.

[25]  G. Breithardt,et al.  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. , 1996 .

[26]  P. Stein,et al.  Heart Rate Variability: Measurement and Clinical Utility , 2005, Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc.

[27]  E. Ivers,et al.  Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock , 2001 .

[28]  T. Osborn,et al.  Emergency medicine and the surviving sepsis campaign: an international approach to managing severe sepsis and septic shock. , 2005, Annals of emergency medicine.

[29]  Cheng-Deng Kuo,et al.  Characteristics of heart rate variability can predict impending septic shock in emergency department patients with sepsis. , 2007, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.