Heart Rate Variability, Clinical and Laboratory Measures to Predict Future Deterioration in Patients Presenting With Sepsis

Shock
Douglas P BarnabyAndrew J E Seely

Abstract

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. 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. 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 variables was 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 (inciden...Continue Reading

References

Oct 1, 1985·Critical Care Medicine·W A KnausJ E Zimmerman
Oct 6, 2001·QJM : Monthly Journal of the Association of Physicians·C P SubbeL Gemmel
Aug 23, 2002·Physical Review Letters·Madalena CostaC-K Peng
Sep 6, 2002·Journal of General Internal Medicine·Steven McGee
Apr 16, 2008·The American Journal of Emergency Medicine·Wei-Lung ChenLiang-Shong Lee
Dec 19, 2009·Critical Care : the Official Journal of the Critical Care Forum·Saif AhmadAndrew Je Seely
Oct 4, 2011·Critical Care Medicine·Tara LaguPeter K Lindenauer
Nov 1, 2011·Journal of Hospital Medicine : an Official Publication of the Society of Hospital Medicine·Vincent LiuGabriel J Escobar
Dec 17, 2011·Journal of Critical Care·Beverly BradleyAndrew J E Seely
Jun 4, 2013·Journal of Critical Care·Geoffrey C GreenAndrew J E Seely
Apr 10, 2014·Critical Care : the Official Journal of the Critical Care Forum·Andrew J E SeelyUNKNOWN Canadian Critical Care Trials Group (CCCTG)
Jun 28, 2014·Critical Care : the Official Journal of the Critical Care Forum·Shun YuMichelle Ng Gong
Mar 19, 2015·The American Journal of the Medical Sciences·Jim Tseng, Kenneth Nugent
Dec 19, 2015·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·R Andrew TaylorM Kennedy Hall
Feb 24, 2016·JAMA : the Journal of the American Medical Association·Christopher W SeymourDerek C Angus
Jun 12, 2016·Annals of Emergency Medicine·Donald M Yealy
Oct 30, 2016·Critical Care Medicine·Charles L SprungRobert A Balk
Jan 24, 2017·JAMA : the Journal of the American Medical Association·Eamon P RaithUNKNOWN Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcomes and Resource Evaluation (CORE)

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Citations

Mar 15, 2019·Shock·Matthias Majetschak

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