Heart rate variabili measures as predictors of in-hospital mortality in ED patients with sepsis
Heart rate variabili measures as predictors of in-hospital mortality in ED patients with sepsis
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DOI：
10.1016/j.ajem.2007.06.016
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发表时间：
2008-05-01
影响因子：
3.6
通讯作者：
Lee, Liang-Shong
中科院分区：
文献类型：
--
作者：
Chen, Wei-Lung;Chen, Jiann-Hwa;Lee, Liang-Shong
目的：确定急诊科脓毒症患者心率变异性（HRV）指标对住院死亡的预测能力。
方法：这是一项前瞻性观察研究。连续纳入一所大学教学医院急诊科在6个月期间符合脓毒症标准的患者队列。在急诊科获取一般人口统计学资料、生命体征、实验室数据以及急诊科脓毒症死亡评分；查阅住院病历；记录一系列连续10分钟的心电图信号用于离线HRV分析，以评估患者的住院死亡率。
结果：132名符合纳入标准、年龄在27至86岁的患者被纳入研究。根据住院结局，患者被分为两组：未存活者（n = 10）和存活者（n = 122）。未存活者的基线HRV指标，包括SDNN、TP、VLFP、LFP以及LFP/HFP比值，显著低于存活者，而nHFP则显著高于存活者。多因素逻辑回归模型确定SDNN和nHFP是预测急诊科脓毒症患者住院死亡率的重要独立变量。SDNN和nHFP预测死亡风险的受试者工作特征曲线下面积分别为0.700和0.739。
结论：心率变异性指标，尤其是SDNN和nHFP，可作为急诊科就诊的脓毒症患者住院死亡率的有价值预测指标。（c）2008爱思唯尔公司。保留所有权利。
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. (c) 2008 Elsevier Inc. All rights reserved.