心率波动可预测重症监护病房危重症患者的死亡率：一项回顾性队列研究。

Heart rate fluctuation predicts mortality in critically ill patients in the intensive care unit: a retrospective cohort study.

作者信息

Guo Qi, Xiao Zhanchao, Lin Maohuan, Yuan Guiyi, Qiu Qiong, Yang Ying, Zhao Huiying, Zhang Yuling, Zhou Shuxian, Wang Jingfeng

机构信息

Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China.

Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China.

出版信息

Ann Transl Med. 2021 Feb;9(4):334. doi: 10.21037/atm-20-7897.

BACKGROUND

To evaluate the association between heart rate (HR) fluctuation and mortality in critically ill patients in the intensive care unit (ICU).

METHODS

A total of 27,814 patients were enrolled from the Medical Information Mart for Intensive Care database and were divided into 3 groups: low HR fluctuation [<25 beats per minute (bpm)], control (25-34 bpm), and high HR fluctuation (≥35 bpm), based on the initial 24-hour HR fluctuation (calculated as the maximum HR minus minimum HR). Multivariate Cox regression and restricted cubic spline models were used.

RESULTS

Compared to the control group, higher risk of 28-day and 1-year mortality remained significant in an adjusted model, with hazard ratios of 1.210 [95% confidence interval (CI), 1.103-1.327] and 1.150 (95% CI, 1.078-1.227), respectively, in the high HR fluctuation group, as well as hazard ratios of 1.130 (95% CI, 1.035-1.232) and 1.087 (95% CI, 1.022-1.157), respectively, in the low HR fluctuation group. Restricted cubic splines showed a U-type curve, with the lowest risk of mortality at an HR fluctuation of 30 bpm.

CONCLUSIONS

This retrospective cohort study revealed that both high and low HR fluctuation correlated with increased mortality in critically ill ICU patients, providing new insights for optimizing HR control strategies.

背景

评估重症监护病房（ICU）危重症患者心率（HR）波动与死亡率之间的关联。

方法

从重症监护医学信息数据库中纳入27814例患者，根据最初24小时的HR波动情况（计算为最高心率减去最低心率）分为3组：低HR波动[<25次/分钟（bpm）]、对照组（25 - 34 bpm）和高HR波动（≥35 bpm）。使用多变量Cox回归和受限立方样条模型。

结果

与对照组相比，在调整模型中，高HR波动组28天和1年死亡率的风险仍然显著升高，风险比分别为1.210 [95%置信区间（CI），1.103 - 1.327]和1.150（95% CI，1.078 - 1.227），低HR波动组的风险比分别为1.130（95% CI，1.035 - 1.232）和1.087（95% CI，1.022 - 1.157）。受限立方样条显示为U型曲线，HR波动为30 bpm时死亡率风险最低。