HEART RATE VARIABILITY, CLINICAL AND LABORATORY MEASURES TO PREDICT FUTURE DETERIORATION IN PATIENTS PRESENTING WITH SEPSIS
HEART RATE VARIABILITY, CLINICAL AND LABORATORY MEASURES TO PREDICT FUTURE DETERIORATION IN PATIENTS PRESENTING WITH SEPSIS
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DOI：
10.1097/shk.0000000000001192
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发表时间：
2019-04-01
期刊：
影响因子：
3.1
通讯作者：
Seely, Andrew J. E.
中科院分区：
文献类型：
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作者：
Barnaby, Douglas P.;Fernando, Shannon M.;Seely, Andrew J. E.
背景：对急诊科 (ED) 脓毒症患者进行风险分层可能具有挑战性。我们推导出并评估了包含临床、实验室和心率变异性 (HRV) 测量的预测模型的性能，以量化该人群的恶化风险。方法：纳入 21 岁及以上、满足 1992 年脓毒症共识会议标准并能够同意（直接或通过代理人）的 ED 患者 (n = 1,247)。患者在 ED 出现后 1 小时内记录临床、实验室和 HRV 数据，并在 72 小时内进行随访以确定病情恶化。结果：832 名患者拥有完整的数据，其中 68 名（8%）达到至少一个终点。最佳预测性能源自实验室值和 HRV 指标的组合，受试者工作曲线下面积 (AUROC) 为 0.80（95% CI，0.65-0.92）。这种变量组合优于单独的临床（AUROC = 0.69，95% CI，0.54-0.83）、实验室（AUROC = 0.77，95% CI，0.63-0.90）和 HRV 测量（AUROC = 0.76，95% CI，0.61-0.90）。 HRV+LAB 模型确定了恶化风险增加 4.3 倍（95% CI，3.2-5.4）（恶化发生率：35%）的高风险患者组（占所有患者的 14%），以及恶化风险增加 0.2 倍（95% CI，0.1-0.4）（恶化发生率：2%）的低风险组（占所有患者的 61%）。结论：结合 HRV 和实验室值的模型可以帮助急诊医生评估脓毒症患者病情恶化的风险，值得验证和进一步评估。
Background: Risk stratification of patients presenting to the emergency department (ED) with sepsis can be challenging. We derived and evaluated performance of a predictive model containing clinical, laboratory, and heart rate variability (HRV) measures to quantify risk of deterioration in this population. Methods: ED patients aged 21 and older satisfying the 1992 consensus conference criteria for sepsis and able to consent (directly or through a surrogate) were enrolled (n = 1,247). Patients had clinical, laboratory, and HRV data recorded within 1 h of ED presentation, and were followed to identify deterioration within 72 h. Results: Eight hundred thirty-two patients had complete data, of whom 68 (8%) reached at least one endpoint. Optimal predictive performance was derived from a combination of laboratory values and HRV metrics with an area under the receiver-operating curve (AUROC) of 0.80 (95% CI, 0.65-0.92). This combination of variableswas superior to clinical (AUROC = 0.69, 95% CI, 0.54-0.83), laboratory (AUROC = 0.77, 95% CI, 0.63-0.90), and HRV measures (AUROC = 0.76, 95% CI, 0.61-0.90) alone. The HRV+LAB model identified a high-risk cohort of patients (14% of all patients) with a 4.3-fold (95% CI, 3.2-5.4) increased risk of deterioration (incidence of deterioration: 35%), as well as a low-risk group (61% of all patients) with 0.2-fold (95% CI 0.1-0.4) risk of deterioration (incidence of deterioration: 2%). Conclusions: A model that combines HRV and laboratory values may help ED physicians evaluate risk of deterioration in patients with sepsis and merits validation and further evaluation.