Division of Critical Care Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL.
Pediatr Crit Care Med. 2021 Aug 1;22(8):e437-e447. doi: 10.1097/PCC.0000000000002707.
Determine whether the Heart Rate Variability Dysfunction score, a novel age-normalized measure of autonomic nervous system dysregulation, is associated with the development of new or progressive multiple organ dysfunction syndrome or death in critically ill children.
DESIGN, SETTING, AND PATIENTS: This was a retrospective, observational cohort study from 2012 to 2018. Patients admitted to the PICU with at least 12 hours of continuous heart rate data available from bedside monitors during the first 24 hours of admission were included in the analysis.
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Heart rate variability was measured using the integer heart rate variability, which is the sd of the heart rate sampled every 1 second over 5 consecutive minutes. The Heart Rate Variability Dysfunction score was derived from age-normalized values of integer heart rate variability and transformed, so that higher scores were indicative of lower integer heart rate variability and a proxy for worsening autonomic nervous system dysregulation. Heart Rate Variability Dysfunction score performance as a predictor of new or progressive multiple organ dysfunction syndrome and 28-day mortality were determined using the area under the receiver operating characteristic curve. Of the 7,223 patients who met inclusion criteria, 346 patients (4.8%) developed new or progressive multiple organ dysfunction syndrome, and 103 (1.4%) died by day 28. For every one-point increase in the median Heart Rate Variability Dysfunction score in the first 24 hours of admission, there was a 25% increase in the odds of new or progressive multiple organ dysfunction syndrome and a 51% increase in the odds of mortality. The median Heart Rate Variability Dysfunction score in the first 24 hours had an area under the receiver operating characteristic curve to discriminate new or progressive multiple organ dysfunction syndrome of 0.67 and to discriminate mortality of 0.80. These results were reproducible in a temporal validation cohort.
The Heart Rate Variability Dysfunction score, an age-adjusted proxy for autonomic nervous system dysregulation derived from bedside monitor data is independently associated with new or progressive multiple organ dysfunction syndrome and mortality in PICU patients. The Heart Rate Variability Dysfunction score could potentially be used as a single continuous physiologic biomarker or as part of a multivariable prediction model to increase awareness of at-risk patients and augment clinical decision-making.
确定心率变异性功能障碍评分是否与危重症儿童新发生或进展性多器官功能障碍综合征或死亡有关，心率变异性功能障碍评分是一种新的、年龄校正的自主神经功能失调指标。
设计、地点和患者：这是一项回顾性、观察性队列研究，时间为 2012 年至 2018 年。分析纳入了至少在入院后 24 小时内连续 12 小时从床边监护仪获得连续心搏数据的 PICU 入院患者。
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使用整数心率变异性测量心率变异性，这是连续 5 分钟每 1 秒采样的心率的标准差。心率变异性功能障碍评分是从年龄校正的整数心率变异性值中导出的，并进行了转换，因此较高的分数表示较低的整数心率变异性，代表自主神经功能失调的恶化。使用接受者操作特征曲线下的面积来确定心率变异性功能障碍评分作为新发生或进展性多器官功能障碍综合征和 28 天死亡率的预测指标。在符合纳入标准的 7223 名患者中，346 名（4.8%）发生新发生或进展性多器官功能障碍综合征，103 名（1.4%）在第 28 天死亡。入院后前 24 小时中位数心率变异性功能障碍评分每增加 1 分，新发生或进展性多器官功能障碍综合征的可能性增加 25%，死亡率增加 51%。前 24 小时中位数心率变异性功能障碍评分对新发生或进展性多器官功能障碍综合征的鉴别诊断的受试者工作特征曲线下面积为 0.67，对死亡率的鉴别诊断的受试者工作特征曲线下面积为 0.80。这些结果在时间验证队列中具有可重复性。
心率变异性功能障碍评分是一种基于床边监护仪数据的自主神经功能失调年龄校正替代指标，与 PICU 患者的新发生或进展性多器官功能障碍综合征和死亡率独立相关。心率变异性功能障碍评分可能可作为单一连续生理生物标志物或作为多变量预测模型的一部分，以提高对高危患者的认识，并增强临床决策。
