Papaioannou Vasilios E, Sertaridou Eleni N, Chouvarda Ioanna G, Kolios George C, Pneumatikos Ioannis N
Intensive Care Unit, Alexandroupolis University Hospital, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece.
Laboratory of Computing, Medical Informatics and Biomedical Imaging Technologies, Faculty of Medicine, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece.
Intensive Care Med Exp. 2019 Sep 5;7(1):53. doi: 10.1186/s40635-019-0267-9.
A few studies have demonstrated that critically ill patients exhibit circadian deregulation and reduced complexity of different time series, such as temperature.
In this prospective study, we enrolled 21 patients divided into three groups: group A (N = 10) included subjects who had septic shock at the time of ICU entry, group B (N = 6) included patients who developed septic shock during ICU stay, and group C consisted of 5 non-septic critically ill patients. Core body temperature (CBT) was recorded for 24 h at a rate of one sample per hour (average of CBT for that hour) and during different occasions: upon ICU entry and exit in groups A and C and upon entry, septic shock development, and exit in group B. Markers of circadian rhythmicity included mean values, amplitude that is the difference between peak and mean values, and peak time. Furthermore, recurrence quantification analysis (RQA) was employed for assessing different markers of complexity of temperature signals. Patients from group C exhibited higher temperature amplitude upon entry (0.45 ± 0.19) in relation with both groups A (0.28 ± 0.18, p < 0.05) and B (0.32 ± 0.13, p < 0.05). Circadian features did not differ within all groups. Temperature amplitude in groups B and C upon entry was negatively correlated with SAPS II (r = - 0.72 and - 0.84, p < 0.003) and APACHE II scores (r = - 0.70 and - 0.63, p < 0.003), respectively, as well as duration of ICU and hospital stay in group B (r = - 0.62 and - 0.64, p < 0.003) and entry SOFA score in group C (r = - 0.82, p < 0.003). Increased periodicity of CBT was found for all patients upon exit related to entry in the ICU. Different RQA features indicating periodic patterns of change of entry CBT were negatively correlated with severity of disease and length of ICU stay for all patients.
Increased temperature rhythmicity during ICU entry was related with lower severity of disease and better clinical outcomes, whereas the more deterministic CBT patterns were found in less critically ill patients with shorter ICU stay.
一些研究表明，危重症患者表现出昼夜节律失调，不同时间序列（如体温）的复杂性降低。
在这项前瞻性研究中，我们纳入了21例患者，分为三组：A组（N = 10）包括入住重症监护病房（ICU）时患有感染性休克的患者，B组（N = 6）包括在ICU住院期间发生感染性休克的患者，C组由5例非感染性危重症患者组成。每小时记录一次核心体温（CBT），共记录24小时（该小时CBT的平均值），记录时间点包括：A组和C组患者入住和出院时，B组患者入住、发生感染性休克和出院时。昼夜节律的指标包括平均值、峰值与平均值之差即振幅以及峰值时间。此外，采用递归定量分析（RQA）评估体温信号复杂性的不同指标。C组患者入住时的体温振幅（0.45±0.19）高于A组（0.28±0.18，p<0.05）和B组（0.32±0.13，p<0.05）。所有组内的昼夜节律特征无差异。B组和C组患者入住时的体温振幅分别与简化急性生理学评分II（SAPS II）（r = -0.72和-0.84，p<0.003）和急性生理与慢性健康状况评分II（APACHE II）（r = -0.70和-0.63，p<0.003）呈负相关，也分别与B组的ICU住院时间和住院时间（r = -0.62和-0.64，p<0.003）以及C组的入住序贯器官衰竭评估（SOFA）评分（r = -0.82，p<0.003）呈负相关。所有患者出院时的CBT周期性相对于入住ICU时均增加。所有患者中，表明入住时CBT变化周期性模式的不同RQA特征与疾病严重程度和ICU住院时间呈负相关。
入住ICU期间体温节律性增加与疾病严重程度较低和更好的临床结局相关，而在病情较轻、ICU住院时间较短的患者中发现CBT模式的确定性更高。
