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Heart rate variability as predictor of mortality in sepsis: A systematic review

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  • Fábio M de Castilho
  • Antonio Luiz P Ribeiro
  • Vandack Nobre
  • Guilherme Barros
  • Marcos R de Sousa

Abstract

Background: 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. Methods: 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). Results: 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. Conclusions: 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.

Suggested Citation

  • Fábio M de Castilho & Antonio Luiz P Ribeiro & Vandack Nobre & Guilherme Barros & Marcos R de Sousa, 2018. "Heart rate variability as predictor of mortality in sepsis: A systematic review," PLOS ONE, Public Library of Science, vol. 13(9), pages 1-13, September.
    • Handle: RePEc:plo:pone00:0203487
    DOI: 10.1371/journal.pone.0203487
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    References listed on IDEAS

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    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. Alessandro Liberati & Douglas G Altman & Jennifer Tetzlaff & Cynthia Mulrow & Peter C Gøtzsche & John P A Ioannidis & Mike Clarke & P J Devereaux & Jos Kleijnen & David Moher, 2009. "The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-28, July.
    3. Lyudmila V. Borovikova & Svetlana Ivanova & Minghuang Zhang & Huan Yang & Galina I. Botchkina & Linda R. Watkins & Haichao Wang & Naji Abumrad & John W. Eaton & Kevin J. Tracey, 2000. "Vagus nerve stimulation attenuates the systemic inflammatory response to endotoxin," Nature, Nature, vol. 405(6785), pages 458-462, May.
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    1. Shu-Jung Wang & Yun-Chen Chang & Wen-Yu Hu & Yuh-Ming Chang & Chi Lo, 2022. "The Comparative Effect of Reduced Mindfulness-Based Stress on Heart Rate Variability among Patients with Breast Cancer," IJERPH, MDPI, vol. 19(11), pages 1-13, May.
    2. Chan-Young Kwon, 2023. "The Impact of SARS-CoV-2 Infection on Heart Rate Variability: A Systematic Review of Observational Studies with Control Groups," IJERPH, MDPI, vol. 20(2), pages 1-19, January.

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