Prognostic impact of autonomic information flow in multiple organ dysfunction syndrome patients.

BACKGROUND Multiple organ dysfunction syndrome (MODS) is the sequential failure of several organ systems after a trigger event, like cardiogenic shock or decompensated heart failure. Mortality is high, up to 70%. Autonomic dysfunction (AD) may substantially contribute to the development of MODS. In cardiology, it has recently been shown that nonlinear parameters could predict mortality. Our study aimed at 1. characterising the complex characteristics of AD of critically ill MODS patients by the nonlinear parameters of autonomic information flow (AIF), 2. comparing AIF with autonomic function of healthy controls, and 3. characterising the accuracy of this parameter in predicting mortality in MODS. METHODS We enrolled 43 score-defined MODS patients who were consecutively admitted to a twelve-bed medical intensive care unit in a university centre into this prospective outcome study. Additionally, we assigned 50 healthy controls to the study. AIF was assessed as a complexity function of AD using 24-h ECG. Measures of AIF were introduced according to the standard HRV concept. The patients were followed up for 28-day mortality. RESULTS MODS causes a disorganisation of short term AIF in favour of an enhanced (rigid) long term AIF. Concerning prognosis increased short term AIF was associated with survival. Short term AIF discriminated between MODS survivors and non-survivors at the level of APACHE II score. CONCLUSIONS This is the first study providing evidence that complex AD of MODS patients is specifically assessed by AIF time scales and that AIF has significant prognostic impact.

[1]  M. Piepoli,et al.  Spectral analysis of heart rate variability in the sepsis syndrome , 1993, Clinical Autonomic Research.

[2]  R Colombo,et al.  Augmented peripheral chemosensitivity as a potential input to baroreflex impairment and autonomic imbalance in chronic heart failure. , 1997, Circulation.

[3]  Giuseppe Baselli,et al.  Measuring regularity by means of a corrected conditional entropy in sympathetic outflow , 1998, Biological Cybernetics.

[4]  Kevin J. Tracey,et al.  The inflammatory reflex , 2002, Nature.

[5]  G G Haddad,et al.  Heart rate control in normal and aborted-SIDS infants. , 1993, The American journal of physiology.

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

[7]  C. Libert.  Inflammation: A nervous connection , 2003, Nature.

[8]  Denis Mestivier,et al.  Quantification of sympathetic and parasympathetic tones by nonlinear indexes in normotensive rats. , 1998, American journal of physiology. Heart and circulatory physiology.

[9]  G. Clermont,et al.  Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and associated costs of care , 2001, Critical care medicine.

[10]  Jonathan Cohen.  The immunopathogenesis of sepsis , 2002, Nature.

[11]  S. Hillebrand,et al.  Chemoreflexsensitivity in Patients with Survived Sudden Cardiac Arrest and Prior Myocardial Infarction , 2000, Pacing and clinical electrophysiology : PACE.

[12]  H. Frndova,et al.  Novel method to quantify loss of heart rate variability in pediatric multiple organ failure* , 2003, Critical care medicine.

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

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

[15]  John Trinder,et al.  Sleep and circadian influences on cardiac autonomic nervous system activity. , 1997, American journal of physiology. Heart and circulatory physiology.

[16]  Brahm Goldstein,et al.  Linear and nonlinear analysis of hemodynamic signals during sepsis and septic shock , 2000, Critical care medicine.

[17]  K. Reinhart,et al.  Direct costs of severe sepsis in three German intensive care units based on retrospective electronic patient record analysis of resource use , 2002, Intensive Care Medicine.

[18]  M. P. Griffin,et al.  Sample entropy analysis of neonatal heart rate variability. , 2002, American journal of physiology. Regulatory, integrative and comparative physiology.

[19]  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.

[20]  G E Morfill,et al.  Complexity Diagnostics in Cardiology: Fundamental Considerations , 1994, Pacing and clinical electrophysiology : PACE.

[21]  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.

[22]  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 .

[23]  G. Schmidt,et al.  Complexity Diagnostics in Cardiology: Methods , 1994, Pacing and clinical electrophysiology : PACE.

[24]  J. Clairambault,et al.  Linear and non-linear analyses of heart rate variability: a minireview. , 1996, Cardiovascular research.

[25]  J. Bigger,et al.  Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction , 1998, The Lancet.

[26]  W. Scott,et al.  Heart rate variability after acute traumatic brain injury in children , 2000, Critical care medicine.

[27]  Jørgen K. Kanters,et al.  Short- and long-term variations in non-linear dynamics of heart rate variability. , 1996, Cardiovascular research.

[28]  U Zwiener,et al.  Characterization of complex heart rate dynamics and their pharmacological disorders by non-linear prediction and special data transformations. , 1996, Cardiovascular research.

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

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

[31]  R. Prescott,et al.  Prospective study of heart rate variability and mortality in chronic heart failure: results of the United Kingdom heart failure evaluation and assessment of risk trial (UK-heart). , 1998, Circulation.

[32]  W. Knaus,et al.  APACHE II: a severity of disease classification system. , 1985 .

[33]  A Schirdewan,et al.  Multiparametric Analysis of Heart Rate Variability Used for Risk Stratification Among Survivors of Acute Myocardial Infarction , 1998, Pacing and clinical electrophysiology : PACE.

[34]  T G Buchman,et al.  Uncoupling of biological oscillators: a complementary hypothesis concerning the pathogenesis of multiple organ dysfunction syndrome. , 1996, Critical care medicine.

[35]  D. Hoyer,et al.  Impaired chemoreflex sensitivity in adult patients with multiple organ dysfunction syndrome—the potential role of disease severity , 2004, Intensive Care Medicine.

[36]  K. Werdan,et al.  Autonomic dysfunction in the ICU patient , 2001, Current opinion in critical care.

[37]  A. Seely,et al.  Multiple organ dysfunction syndrome: Exploring the paradigm of complex nonlinear systems , 2000, Critical care medicine.

[38]  M. Piepoli,et al.  Chemo- and ergoreflexes in health, disease and ageing. , 2005, International journal of cardiology.

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

[40]  P Van Leeuwen,et al.  Circadian aspects of apparent correlation dimension in human heart rate dynamics. , 1995, The American journal of physiology.

[41]  Ki H. Chon,et al.  Mutual information function assesses autonomic information flow of heart rate dynamics at different time scales , 2005, IEEE Transactions on Biomedical Engineering.

[42]  Julián J. González,et al.  Detection and sources of nonlinearity in the variability of cardiac R-R intervals and blood pressure in rats. , 2000, American journal of physiology. Heart and circulatory physiology.