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Observational Study
. 2020 Dec;38(12):2607-2613.
doi: 10.1016/j.ajem.2020.01.012. Epub 2020 Jan 7.

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

John E Arbo  1 , Jeremy K Lessing  2 , William J H Ford  2 , Sunday Clark  2 , Eli Finkelsztein  2 , Edward J Schenck  3 , Rahul Sharma  2 , Paul M Heerdt  4
Affiliations
Observational Study

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

John E Arbo et al. Am J Emerg Med. 2020 Dec.

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.

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Conflict of interest statement

Declaration of competing interest JEA reports no conflict of interest. JKL reports no conflict of interest. WJHF reports no conflict of interest. SC reports no conflict of interest. EF reports no conflict of interest. EJS reports no conflict of interest. RS reports no conflict of interest. PMH reports the following: 1.) Co-founder RVMetrics, LLC; 2) Sponsored research for Caretaker Medical.

Figures

Figure 1, 2, & 3:
Figure 1, 2, & 3:
Boxplot: The boxplot compactly displays the distribution of a continuous variable. It graphs five summary statistics (the median, two hinges and two whiskers), and all “outlying” points individually. The band inside the box represents the second quartile (the median). The lower and upper hinges correspond to the first and third quartiles (the 25th and 75th percentiles). The upper whisker extends from the hinge to the largest value no further than 1.5 * IQR from the hinge (where IQR is the inter-quartile range, or distance between the first and third quartiles). The lower whisker extends from the hinge to the smallest value at most 1.5 * IQR of the hinge. Data beyond the end of the whiskers are “outlying” points plotted individually.
Figure 1, 2, & 3:
Figure 1, 2, & 3:
Boxplot: The boxplot compactly displays the distribution of a continuous variable. It graphs five summary statistics (the median, two hinges and two whiskers), and all “outlying” points individually. The band inside the box represents the second quartile (the median). The lower and upper hinges correspond to the first and third quartiles (the 25th and 75th percentiles). The upper whisker extends from the hinge to the largest value no further than 1.5 * IQR from the hinge (where IQR is the inter-quartile range, or distance between the first and third quartiles). The lower whisker extends from the hinge to the smallest value at most 1.5 * IQR of the hinge. Data beyond the end of the whiskers are “outlying” points plotted individually.
Figure 1, 2, & 3:
Figure 1, 2, & 3:
Boxplot: The boxplot compactly displays the distribution of a continuous variable. It graphs five summary statistics (the median, two hinges and two whiskers), and all “outlying” points individually. The band inside the box represents the second quartile (the median). The lower and upper hinges correspond to the first and third quartiles (the 25th and 75th percentiles). The upper whisker extends from the hinge to the largest value no further than 1.5 * IQR from the hinge (where IQR is the inter-quartile range, or distance between the first and third quartiles). The lower whisker extends from the hinge to the smallest value at most 1.5 * IQR of the hinge. Data beyond the end of the whiskers are “outlying” points plotted individually.
Figure 4:
Figure 4:. Age-adjusted LF and HF signal vs. Age and Sepsis Subtype
4A: Age-adjusted LF: Sepsis (β - 0.52; 95% CI −0.98, −0.06, p = 0.03), severe sepsis (β - 0.66; 95% CI −1.31, −0.01, p = 0.05), septic shock (β - 0.70; 95% CI −1.38, −0.02, p = 0.04) 4B: Age-adjusted HF: Sepsis (β 0.49; 95% CI 0.01, 0.87, p = 0.02), severe sepsis (β 0.65; 95% CI 0.03, 1.28, p = 0.04), and septic shock (β 0.73; 95% CI 0.14, 1.32, p = 0.02)
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References

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