心率变异性与小儿急性肝衰竭中的脑病及预后相关。
Heart rate variability is associated with encephalopathy and outcomes in pediatric acute liver failure.
作者信息
Pendergrast Tricia R, Chapin Catherine A, Kriegermeier Alyssa A, Pardo Andrea C, Bass Lee M, Sanchez-Pinto L Nelson
机构信息
Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Gastroenterology, Hepatology, and Nutrition, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
出版信息
Pediatr Res. 2023 Apr;93(5):1348-1353. doi: 10.1038/s41390-022-02225-2. Epub 2022 Aug 4.
BACKGROUND
More than half of children with pediatric acute liver failure (PALF) experience hepatic encephalopathy (HE), which is related to poor outcomes; however, HE is difficult to diagnose in children. The objective of this study was to evaluate if heart rate variability (HRV), a continuous measure of autonomic nervous system function, was related to the presence and severity of HE as well as clinical outcomes in children with PALF.
METHODS
We conducted a retrospective observational cohort study of 38 critically ill children with PALF to examine the association between HRV and HE severity and clinical outcome. HRV was estimated using the integer HRV (HRVi). Categorical variables were compared using the Fisher Exact test and continuous variables were compared using Kruskal-Wallis tests. Associations between grades of HE and minimum and median HRVi were evaluated with Pearson's correlation, with p values <0.05 considered significant.
RESULTS
A more negative median and minimum HRVi, indicating poorer autonomic nervous system function, was significantly associated with abnormal EEG findings, presence of HE, and poor outcomes (death or listing for transplant).
CONCLUSIONS
Heart rate variability may hold promise to predict outcomes in children with PALF, but these findings should be replicated in a larger sample.
IMPACT
The findings of our study suggest that heart rate variability is associated with clinical outcomes in children with acute liver failure, a cohort for which prognostics are challenging, especially in young children and infants. Use of heart rate variability in the clinical setting may facilitate earlier detection of children with pediatric acute liver failure (PALF) at high risk for severe hepatic encephalopathy and poor outcomes. Identification of children with PALF at high risk of decompensation may assist clinicians in making decisions about liver transplantation, an important, but resource-limited, treatment of PALF.
背景
超过半数的小儿急性肝衰竭（PALF）患儿会出现肝性脑病（HE），这与不良预后相关；然而，HE在儿童中难以诊断。本研究的目的是评估心率变异性（HRV），一种自主神经系统功能的连续测量指标，是否与PALF患儿的HE存在及严重程度以及临床结局相关。
方法
我们对38例患有PALF的危重症儿童进行了一项回顾性观察队列研究，以检查HRV与HE严重程度及临床结局之间的关联。使用整数HRV（HRVi）评估HRV。分类变量采用Fisher精确检验进行比较，连续变量采用Kruskal-Wallis检验进行比较。采用Pearson相关性评估HE分级与最小和中位数HRVi之间的关联，p值<0.05被认为具有统计学意义。
结果
中位数和最小HRVi越负，表明自主神经系统功能越差，与脑电图异常结果、HE的存在以及不良结局（死亡或列入移植名单）显著相关。
结论
心率变异性可能有望预测PALF患儿的结局，但这些发现应在更大样本中得到重复验证。
影响
我们的研究结果表明，心率变异性与急性肝衰竭患儿的临床结局相关，这一群体的预后具有挑战性，尤其是在幼儿和婴儿中。在临床环境中使用心率变异性可能有助于早期发现患有严重肝性脑病和不良结局高风险的小儿急性肝衰竭（PALF）患儿。识别具有失代偿高风险的PALF患儿可能有助于临床医生做出关于肝移植的决策，肝移植是PALF的一种重要但资源有限的治疗方法。
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