Correlation analysis between heart rate variability and severity of sepsis
ZHANG Zekui1 LONG Jiangchao1 ZHANG Xiaoqin2
1.Department of Critical Medicine, People′s Hospital of Aba Tibetan and Qiang Autonomous Prefecture, Sichuan Province, Maerkang 624000, China;
2.Department of Critical Medicine, Sichuan Academy of Medical Sciences Sichuan People′s Hospital, Sichuan Province, Chengdu 610072, China
Abstract：Objective To explore the correlation between heart rate variability and severity and prognosis of sepsis. Methods A total of 98 sepsis patients (observation group) admitted to People′s Hospital of Aba Tibetan and Qiang Autonomous Prefecture from January 2017 to January 2019 were selected, while according to acute physiology and chronic health evaluation (APACHE Ⅱ) score, the observation group was divided into sepsis group (0-10 scores, 39 cases), severe sepsis group (11-20 scores, 32 cases) and sepsis shock group (＞20 scores, 27 cases). A total of 50 healthy patients (control group) in the same period were selected for dynamic electrocardiogram. Heart rate variability parameters (standard deviation of normal-to-normal intervals [SDNN], standard deviation of averaged normal-to-normal intervals [SDANN], root of the mean square of successive differences [rMSSD], percentage of adjacent normal-to -normal intervals differing by more than 50 ms [PNN50], low frequency [LF], high frequency [HF], LF/HF) were recorded. The heart rate variability parameters, APACHE Ⅱ score and prognosis were analyzed. Results The SDNN, LF, LF/HF in the observation group were lower than those in the control group (P < 0.05). The SDNN, LF, LF/HF in the severe sepsis group and septic shock group were lower than those in the sepsis group, while those in the septic shock group were lower than those in the severe sepsis group, and the differences were statistically significant (P < 0.05). SDNN, LF, LF/HF were negatively correlated with APACHE Ⅱ score (r = -0.459, -0.367, -0.405, P < 0.05). The area under the curve (AUC) of SDNN, LF, LF/HF to predict the prognosis of sepsis patients were 0.817, 0.802, and 0.937, respectively. The best cutoff values were 95.21 ms, 5.13 ms, and 0.41, while the sensitivity and specificity were 0.807 and 0.895; 0.645 and 0.881; 0.871 and 0.940, respectively. Conclusion Heart rate variability parameters SDNN, LF, LF/HF are closely related to the severity and prognosis of sepsis, which can be used as sensitive indicators for prognosis prediction.
[1] Dellinger RP，Levy MM，Rhodes A，et al. Surviving Sepsis Campaign： international guidelines for management of severe sepsis and septic shock，2012 [J]. Intensive Care Med，2013，39（2）：165-228.
[2] 王立朋，伊茂礼，徐绣宇，等.脓毒症生物标志物的临床诊断价值[J].中国老年学杂志，2018，38（9）：2288-2292.
[3] Chang YT，Huang WC，Cheng CC，et al. Effects of epinephrine on heart rate variability and cytokines in a rat sepsis model [J]. Bosn J Basic Med Sci，2018，20（1）：7.
[4] Al-Shargabi T，Govindan RB，Dave R，et al. Inflammatory cytokine response and reduced heart rate variability in newborns with hypoxic-ischemic encephalopathy [J]. J Perinatol，2017，37（6）：668-672.
[5] Rana M，Fei-Bloom Y，Son M，et al. Constitutive Vagus Nerve Activation Modulates Immune Suppression in Sepsis Survivors [J]. Front Immunol，2018，9：2032.
[6] Cai K，Ni Y，Zhang Y，et al. Heart rate variability after endovascular coiling is associated with short-term outcomes in patients with subarachnoid hemorrhage [J]. Neurol Res，2018，40（10）：856-861.
[7] Singer M，Deutschman CS，Seymour CW，et al. The Third International Consensus Definitions for Sepsis and Septic Shock（Sepsis-3）[J]. JAMA，2016，315（8）：801-810.
[8] 王胜云，陈德昌.降钙素原和C-反应蛋白与脓毒症患者病情严重程度评分的相关性研究及其对预后的评估价值[J].中华危重病急救医学，2015，27（2）：97-101.
[9] Jarkovska D，Valesova L，Chvojka J，et al. Heart-rate variability depression in porcine peritonitis-induced sepsis without organ failure [J]. Exp Biol Med（Maywood），2017， 242（9）：1005-1012.
[10] de Castilho FM，Ribeiro ALP，da Silva JLP，et al. Heart rate variability as predictor of mortality in sepsis：A prospective cohort study [J]. PLoS One，2017，12（6）：e0180060.
[11] Joshi R，Kommers D，Oosterwijk L，et al. Predicting Neonatal Sepsis Using Features of Heart Rate Variability，Respiratory Characteristics and ECG-Derived Estimates of Infant Motion [J]. IEEE J Biomed Health Inform，2020，3（3）：681-692.
[12] Pong JZ，Fook-Chong S，Koh ZX，et al. Combining Heart Rate Variability with Disease Severity Score Variables for Mortality Risk Stratification in Septic Patients Presenting at the Emergency Department [J]. Int J Environ Res Public Health，2019，16（10）：E1725.
[13] Prabhakar SM，Tagami T，Liu N，et al. Combining quick sequential organ failure assessment score with heart rate variability may improve predictive ability for mortality in septic patients at the emergency department [J]. PLoS One，2019，14（3）：e0213445.
[14] Thungtong A，Knoch MF，Jacono FJ，et al. Periodicity：A Characteristic of Heart Rate Variability Modified by the Type of Mechanical Ventilation After Acute Lung Injury [J]. Front Physiol，2018，9：772.
[15] Hussein MA，Deng N，Rusin C，et al. Heart rate variability changes and its association with the development of severe retinopathy of prematurity [J]. J AAPOS，2018，22（5）：371-375.
[16] Boselli E，Jacquet-Lagrèze M，Ayoub JY，et al. Effects of esmolol on systemic hemodynamics and heart rate variability measured using the Analgesia/Nociception Index in resuscitated piglets with Pseudomonas aeruginosa septic shock [J]. J Vet Emerg Crit Care（San Antonio），2018，28（5）：447-456.
[17] Jalilian H，Zamanian Z，Gorjizadeh O，et al. Autonomic Nervous System Responses to Whole-Body Vibration and Mental Workload：A Pilot Study [J]. Int J Occup Environ Med，2019，10（4）：174-184.
[18] 李娜，李志峰，项辉，等.迷走神经刺激对脓毒症相关性脑病大鼠的保护作用[J].中华危重病急救医学，2015， 27（6）：509-513.
[19] 陈学思，张丽梅，蔡敏敏，等.胆碱能抗炎通路在病毒性心肌炎中的抗炎作用及其机制[J].现代实用医学，2018， 30（9）：1131-1134，1254.
[20] 陈伟，荣爱红，欧珠，等.脓毒血症患者心率变异性和病情危重程度的关系[J].中华实用诊断与治疗杂志，2017， 31（6）：541-544.
[21] Quinten VM，van Meurs M，Renes MH，et al. Protocol of the sepsivit study：a prospective observational study to determine whether continuous heart rate variability measurement during the first 48 hours of hospitalisation provides an early warning for deterioration in patients presenting with infection or sepsis to the emergency department of a Dutch academic teaching hospital [J]. BMJ Open，2017，7（11）：e018259.
[22] Barnaby DP，Fernando SM，Ferrick KJ，et al. Use of the low-frequency/high-frequency ratio of heart rate variability to predict short-term deterioration in emergency department patients with sepsis [J]. Emerg Med J，2018， 35（2）：96-102.
2020, Vol. 17 
京公网安备 11010502046598号