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. 2022 Jun 1;23(6):e289-e294. doi: 10.1097/PCC.0000000000002936. Epub 2022 Mar 16.
The autonomic nervous system (ANS) can both modulate and be modulated by the inflammatory response during critical illness. We aimed to determine whether heart rate variability (HRV), a measure of ANS function, is associated with proinflammatory biomarker levels in critically ill children.
Two cohorts were analyzed. The first was a prospective observational cohort from August 2018 to August 2020 who had plasma proinflammatory cytokine measurements within 72 hours of admission, including tumor necrosis factor-α, interleukin (IL)-1β, IL-6, and IL-8. The second was a retrospective cohort from June 2012 to August 2020 who had at least one C-reactive protein (CRP) measurement within 72 hours of admission.
Forty-six-bed PICU.
Critically ill children in either cohort who had continuous heart rate data available from the bedside monitors.
None.
Sixty-two patients were included in the prospective cohort and 599 patients in the retrospective cohort. HRV was measured using the age-adjusted integer heart rate variability (HRVi), which is the sd of the heart rate sampled every 1 second over 5 consecutive minutes. The median HRVi was measured in the 12-hour period ending 30 minutes prior to inflammatory biomarker collection. HRVi was inversely correlated with IL-6, IL-8, and CRP levels (p ≤ 0.02); correlation with IL-8 and CRP persisted after adjusting for Pediatric Risk of Mortality III and age, and median HR and age (p < 0.001).
HRVi is inversely correlated with IL-6, IL-8, and CRP. Further studies are needed to validate this measure as a proxy for a proinflammatory state.
自主神经系统（ANS）在危重病期间既可以调节炎症反应，也可以被炎症反应调节。我们旨在确定心率变异性（HRV），即 ANS 功能的一种测量方法，是否与危重症儿童的促炎生物标志物水平相关。
分析了两个队列。第一个是前瞻性观察队列，来自 2018 年 8 月至 2020 年 8 月，在入院后 72 小时内进行了血浆促炎细胞因子测量，包括肿瘤坏死因子-α、白细胞介素（IL）-1β、IL-6 和 IL-8。第二个是回顾性队列，来自 2012 年 6 月至 2020 年 8 月，在入院后 72 小时内至少有一次 C-反应蛋白（CRP）测量。
46 床儿科重症监护病房（PICU）。
两个队列中均有连续心率数据可从床边监护仪获得的危重症儿童。
无。
前瞻性队列纳入 62 例患者，回顾性队列纳入 599 例患者。使用年龄调整整数心率变异性（HRVi）测量 HRV，这是连续 5 分钟每 1 秒采样的心率的标准差。在炎症生物标志物采集前 30 分钟结束的 12 小时期间测量 HRVi 的中位数。HRVi 与 IL-6、IL-8 和 CRP 水平呈负相关（p≤0.02）；在调整儿科死亡率风险 III 和年龄、中位数 HR 和年龄后，与 IL-8 和 CRP 的相关性仍然存在（p<0.001）。
HRVi 与 IL-6、IL-8 和 CRP 呈负相关。需要进一步研究来验证该测量方法作为促炎状态的替代指标。
