Initial fractal exponent of heart rate variability is associated with success of early resuscitation in patients with severe sepsis or septic shock: a prospective cohort study.
Initial fractal exponent of heart rate variability is associated with success of early resuscitation in patients with severe sepsis or septic shock: a prospective cohort study.
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DOI：
10.1016/j.jcrc.2013.07.050
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发表时间：
2013-12
影响因子：
3.7
通讯作者：
Morris, Alan
中科院分区：
文献类型：
--
作者：
Brown, Samuel M.;Tate, Quinn;Jones, Jason P.;Knox, Daniel B.;Kuttler, Kathryn G.;Lanspa, Michael;Rondina, Matthew T.;Grissom, Colin K.;Behera, Subhasis;Mathews, V. J.;Morris, Alan
心率变异性反映了自主神经系统的张力以及气压反射系统的整体健康状况。我们假设入住ICU时心率变异性复杂性的丧失与败血症早期复苏失败有关。我们前瞻性地纳入2009 - 2011年重症脓毒症或感染性休克患者。我们研究了ICU入院时的30分钟心电图，采样频率为500 Hz，并通过无趋势波动分析计算心率复杂性。主要终点是ICU入院后24小时血管升压药物的独立性。次要终点为28天死亡率。我们研究了48例患者，其中60%在24小时内血管加压药物不依赖。5例（10%）在28天内死亡。在控制平均心率后，分形α参数的比值与血管加压药物独立性和28天死亡率相关（p=0.04）。在最优模型中，SOFA评分和长期分形α参数与血管加压药物独立性相关。心率变异性复杂性的丧失与严重败血症和感染性休克早期较差的预后相关。进一步的工作应该评估心率变异性（HRV）的复杂性是否可以指导败血症的治疗。
Heart-rate variability reflects autonomic nervous system tone as well as the overall health of the baroreflex system. We hypothesized that loss of complexity in heart-rate variability upon ICU admission would be associated with unsuccessful early resuscitation of sepsis. We prospectively enrolled patients admitted to ICUs with severe sepsis or septic shock from 2009 to 2011. We studied 30 minutes of EKG, sampled at 500 Hz, at ICU admission and calculated heart-rate complexity via detrended fluctuation analysis. Primary outcome was vasopressor independence at 24 hours after ICU admission. Secondary outcome was 28-day mortality. We studied 48 patients, of whom 60% were vasopressor independent at 24 hours. Five (10%) died within 28 days. The ratio of fractal alpha parameters was associated with both vasopressor independence and 28-day mortality (p=0.04) after controlling for mean heart rate. In the optimal model, SOFA score and the long-term fractal alpha parameter were associated with vasopressor independence. Loss of complexity in heart rate variability is associated with worse outcome early in severe sepsis and septic shock. Further work should evaluate whether complexity of heart rate variability (HRV) could guide treatment in sepsis.
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