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Combining Heart Rate Variability with Disease Severity Score Variables for Mortality Risk Stratification in Septic Patients Presenting at the Emergency Department

Author

Listed:
  • Jeremy Zhenwen Pong

    (Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore)

  • Stephanie Fook-Chong

    (Health Services Research Unit, Singapore General Hospital, Singapore 169608, Singapore)

  • Zhi Xiong Koh

    (Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore)

  • Mas’uud Ibnu Samsudin

    (General Medicine, Ministry of Health Holdings, Singapore 099253, Singapore)

  • Takashi Tagami

    (Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo 206-8512, Japan)

  • Calvin J. Chiew

    (Preventive Medicine Residency Program, National University Health System, Singapore 119228, Singapore)

  • Ting Hway Wong

    (Department of General Surgery, Singapore General Hospital, Singapore 169608, Singapore)

  • Andrew Fu Wah Ho

    (Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore)

  • Marcus Eng Hock Ong

    (Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore
    Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore)

  • Nan Liu

    (Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore
    Health Services Research Centre, Singapore Health Services, Singapore 169856, Singapore)

Abstract

The emergency department (ED) serves as the first point of hospital contact for many septic patients, where risk-stratification would be invaluable. We devised a combination model incorporating demographic, clinical, and heart rate variability (HRV) parameters, alongside individual variables of the Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation II (APACHE II), and Mortality in Emergency Department Sepsis (MEDS) scores for mortality risk-stratification. ED patients fulfilling systemic inflammatory response syndrome criteria were recruited. National Early Warning Score (NEWS), Modified Early Warning Score (MEWS), quick SOFA (qSOFA), SOFA, APACHE II, and MEDS scores were calculated. For the prediction of 30-day in-hospital mortality, combination model performed with an area under the receiver operating characteristic curve of 0.91 (95% confidence interval (CI): 0.88–0.95), outperforming NEWS (0.70, 95% CI: 0.63–0.77), MEWS (0.61, 95% CI 0.53–0.69), qSOFA (0.70, 95% CI 0.63–0.77), SOFA (0.74, 95% CI: 0.67–0.80), APACHE II (0.76, 95% CI: 0.69–0.82), and MEDS scores (0.86, 95% CI: 0.81–0.90). The combination model had an optimal sensitivity and specificity of 91.4% (95% CI: 81.6–96.5%) and 77.9% (95% CI: 72.6–82.4%), respectively. A combination model incorporating clinical, HRV, and disease severity score variables showed superior predictive ability for the mortality risk-stratification of septic patients presenting at the ED.

Suggested Citation

  • Jeremy Zhenwen Pong & Stephanie Fook-Chong & Zhi Xiong Koh & Mas’uud Ibnu Samsudin & Takashi Tagami & Calvin J. Chiew & Ting Hway Wong & Andrew Fu Wah Ho & Marcus Eng Hock Ong & Nan Liu, 2019. "Combining Heart Rate Variability with Disease Severity Score Variables for Mortality Risk Stratification in Septic Patients Presenting at the Emergency Department," IJERPH, MDPI, vol. 16(10), pages 1-14, May.
    • Handle: RePEc:gam:jijerp:v:16:y:2019:i:10:p:1725-:d:231644
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    References listed on IDEAS

    as
    1. Fábio M de Castilho & Antonio Luiz P Ribeiro & José Luiz P da Silva & Vandack Nobre & Marcos R de Sousa, 2017. "Heart rate variability as predictor of mortality in sepsis: A prospective cohort study," PLOS ONE, Public Library of Science, vol. 12(6), pages 1-15, June.
    2. Sumanth Madhusudan Prabhakar & Takashi Tagami & Nan Liu & Mas’uud Ibnu Samsudin & Janson Cheng Ji Ng & Zhi Xiong Koh & Marcus Eng Hock Ong, 2019. "Combining quick sequential organ failure assessment score with heart rate variability may improve predictive ability for mortality in septic patients at the emergency department," PLOS ONE, Public Library of Science, vol. 14(3), pages 1-11, March.
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