Heart rate variability as predictor of mortality in sepsis: A systematic review.
Heart rate variability as predictor of mortality in sepsis: A systematic review.
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DOI：
10.1371/journal.pone.0203487
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
de Sousa MR
中科院分区：
文献类型：
--
作者：
de Castilho FM;Ribeiro ALP;Nobre V;Barros G;de Sousa MR
自主神经失调是脓毒症公认的病理生理机制之一，产生了心率变异性（HRV）可用于预测脓毒症死亡率的假设。这是一项评价HRV作为脓毒症患者死亡预测因子的研究的系统性综述。由独立研究人员在PubMed、LILACS和科克伦进行检索，包括英文、葡萄牙文或西班牙文的论文，索引日期为2017年8月20日，至少有10例患者。采用Newcastle-Ottawa量表评价研究质量。为了分析结果，我们将文章分为短期记录（≤ 1小时）和长期记录（≥ 24小时）的HRV测量文章。纳入了9项研究，总计536例患者。所有这些都是观察性研究。研究质量在Newcastle-Ottawa量表中从4到7星不等。研究中的死亡率范围为8%至61%。7项研究在短期记录中进行了HRV分析。除了一项研究没有解释哪一组的结果最低外，所有其他研究都显示，与存活的脓毒症患者相比，非存活者的几个HRV参数降低。SDNN（正常值至正常值区间的标准差），TP（总功率），VLF（甚低频电源），LF（低频电源），LF/HF（低频功率/高频功率），nLF（标准化低频功率），α1/α2（来自DFA的短期和长期分形标度系数）和r-MSSD在至少一项研究中，非存活者组的平均时间（连续NN间期差异的平方根）相对于存活者降低。两项研究发现，SDNN与脓毒症死亡率相关，即使在调整可能的混杂因素后也是如此。三项研究使用长期记录进行HRV分析。这些研究中只有一项发现了存活组和非存活组之间的差异，即使如此，也只有一个HRV参数：LogHF。在短期记录中，几个HRV参数在不存活的脓毒症患者中降低。两项研究发现，SDNN与脓毒症的死亡率相关，即使在调整了可能的混杂因素后也是如此。
Autonomic dysregulation is one of the recognized pathophysiological mechanisms in sepsis, generating the hypothesis that heart rate variability (HRV) can be used to predict mortality in sepsis. This was a systematic review of studies evaluating HRV as a predictor of death in patients with sepsis. The search was performed by independent researchers in PubMed, LILACS and Cochrane, including papers in English, Portuguese or Spanish, indexed until August 20th, 2017 with at least 10 patients. Study quality was assessed by Newcastle-Ottawa Scale. To analyze the results, we divided the articles between those who measured HRV for short-term recordings (≤ 1 hour), and those who did long-term recordings (≥ 24 hours). Nine studies were included with a total of 536 patients. All of them were observational studies. Studies quality varied from 4 to 7 stars in Newcastle-Ottawa Scale. The mortality rate in the studies ranged from 8 to 61%. Seven studies performed HRV analysis in short-term recordings. With the exception of one study that did not explain which group had the lowest results, all other studies showed reduction of several HRV parameters in the non-survivors in relation to the surviving septic patients. SDNN (Standard deviation of the Normal to Normal interval), TP (Total Power), VLF (Very Low Frequency Power), LF (Low Frequency Power), LF/HF (Low Frequency Power / High Frequency Power), nLF (Normalized Low Frequency Power), α1/α2 (short-term and long-term fractal scaling coefficients from DFA) and r-MSSD (Square root of the squared mean of the difference of successive NN-intervals) of the non-survivor group were reduced in relation to the survivors in at least one study. Two studies found that SDNN is associated with mortality in sepsis, even after adjusting for possible confounding factors. Three studies performed HRV analysis using long-term recordings. Only one of these studies found difference between surviving and non-surviving groups, and even so, in only one HRV parameter: LogHF. Several HRV parameters are reduced in nonsurviving septic patients in short-term recording. Two studies have found that SDNN is associated with mortality in sepsis, even after adjusting for possible confounding factors.
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