Lin Yen-Hung, Huang Hui-Chun, Chang Yi-Chung, Lin Chen, Lo Men-Tzung, Liu Li-Yu Daisy, Tsai Pi-Ru, Chen Yih-Sharng, Ko Wen-Je, Ho Yi-Lwun, Chen Ming-Fong, Peng Chung-Kang, Buchman Timothy G
Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Graduate Institute of Communication Engineering, National Taiwan University, Taipei, Taiwan.
Crit Care. 2014 Oct 24;18(5):548. doi: 10.1186/s13054-014-0548-3.
Extracorporeal life support (ECLS) can temporarily support cardiopulmonary function, and is occasionally used in resuscitation. Multi-scale entropy (MSE) derived from heart rate variability (HRV) is a powerful tool in outcome prediction of patients with cardiovascular diseases. Multi-scale symbolic entropy analysis (MSsE), a new method derived from MSE, mitigates the effect of arrhythmia on analysis. The objective is to evaluate the prognostic value of MSsE in patients receiving ECLS. The primary outcome is death or urgent transplantation during the index admission.
Fifty-seven patients receiving ECLS less than 24 hours and 23 control subjects were enrolled. Digital 24-hour Holter electrocardiograms were recorded and three MSsE parameters (slope 5, Area 6-20, Area 6-40) associated with the multiscale correlation and complexity of heart beat fluctuation were calculated.
Patients receiving ECLS had significantly lower value of slope 5, area 6 to 20, and area 6 to 40 than control subjects. During the follow-up period, 29 patients met primary outcome. Age, slope 5, Area 6 to 20, Area 6 to 40, acute physiology and chronic health evaluation II score, multiple organ dysfunction score (MODS), logistic organ dysfunction score (LODS), and myocardial infarction history were significantly associated with primary outcome. Slope 5 showed the greatest discriminatory power. In a net reclassification improvement model, slope 5 significantly improved the predictive power of LODS; Area 6 to 20 and Area 6 to 40 significantly improved the predictive power in MODS. In an integrated discrimination improvement model, slope 5 added significantly to the prediction power of each clinical parameter. Area 6 to 20 and Area 6 to 40 significantly improved the predictive power in sequential organ failure assessment.
MSsE provides additional prognostic information in patients receiving ECLS.
体外生命支持（ECLS）可暂时支持心肺功能，偶尔用于复苏。从心率变异性（HRV）得出的多尺度熵（MSE）是预测心血管疾病患者预后的有力工具。多尺度符号熵分析（MSsE）是一种从MSE衍生出的新方法，可减轻心律失常对分析的影响。目的是评估MSsE在接受ECLS的患者中的预后价值。主要结局是在本次住院期间死亡或紧急移植。
纳入57例接受ECLS时间少于24小时的患者和23例对照受试者。记录数字化24小时动态心电图，并计算与心跳波动的多尺度相关性和复杂性相关的三个MSsE参数（斜率5、面积6 - 20、面积6 - 40）。
接受ECLS的患者的斜率5、面积6至20和面积6至40的值显著低于对照受试者。在随访期间，29例患者达到主要结局。年龄、斜率5、面积6至20、面积6至40、急性生理与慢性健康状况评估II评分、多器官功能障碍评分（MODS）、逻辑器官功能障碍评分（LODS）和心肌梗死病史与主要结局显著相关。斜率5显示出最大的鉴别力。在净重新分类改善模型中，斜率5显著提高了LODS的预测能力；面积6至20和面积6至40显著提高了MODS中的预测能力。在综合鉴别改善模型中，斜率5显著增加了每个临床参数的预测能力。面积6至20和面积6至40在序贯器官衰竭评估中显著提高了预测能力。
MSsE为接受ECLS的患者提供了额外的预后信息。
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