Department of Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
Ann Clin Transl Neurol. 2023 Jul;10(7):1136-1145. doi: 10.1002/acn3.51795. Epub 2023 May 22.
A rapid and accurate forecast for the early prognosis of ICH patients is challenging. This study investigated whether heart rate variability (HRV) and skin sympathetic nerve activity (SKNA) could prognosticate poor neurological outcomes in ICH patients.
Between November 2020 and November 2021, we studied 92 spontaneous ICH patients in the First Affiliated Hospital of Nanjing Medical University. Glasgow Outcome Scale (GOS) score at 2 weeks after the ICH was used to categorize patients into good and poor outcome groups. The modified Rankin Scale (mRS) assessed patients' ability to live independently for 1 year. We utilized a portable high-frequency electrocardiogram (ECG) recording system to record the HRV and SKNA information in ICH patients and control participants.
77 patients were eligible for the prediction of neurological outcome and were allocated into the good (n = 22) or poor (n = 55) outcome groups based on the GOS grade. In univariate logistic regression analysis, significant variables that could differentiate the outcomes were age, hypertension, tracheal intubation, Glasgow Coma Scale (GCS) score, existing intraventricular hemorrhage, white blood cells, neutrophil, lnVLF, lnTP, and aSKNA. Variables in the best fit multivariable logistic regression model were age, hypertension, GCS score, neutrophils, and aSKNA. The GCS score was the only independent risk factor for poor outcomes. At 30 days and 1 year of follow-up, patients with lower aSKNA had poor outcomes.
ICH patients had reduced aSKNA, which could be a prognostic indicator. A lower aSKNA suggested a worse prognosis. The present data indicate that ECG signals could be helpful for prognosticating ICH patients.
对 ICH 患者的早期预后进行快速准确的预测具有挑战性。本研究探讨了心率变异性（HRV）和皮肤交感神经活动（SKNA）是否可预测 ICH 患者的不良神经结局。
2020 年 11 月至 2021 年 11 月，我们研究了南京医科大学第一附属医院的 92 例自发性 ICH 患者。采用格拉斯哥预后量表（GOS）评分在 ICH 后 2 周评估患者的预后，将患者分为预后良好和预后不良两组。改良 Rankin 量表（mRS）评估患者 1 年内独立生活的能力。我们使用便携式高频心电图（ECG）记录系统记录 ICH 患者和对照组的 HRV 和 SKNA 信息。
77 例患者有资格进行神经预后预测，并根据 GOS 分级分为预后良好（n=22）或预后不良（n=55）组。在单变量逻辑回归分析中，能够区分结局的显著变量为年龄、高血压、气管插管、格拉斯哥昏迷量表（GCS）评分、存在脑室内出血、白细胞、中性粒细胞、lnVLF、lnTP 和 aSKNA。多变量逻辑回归模型中最佳拟合的变量为年龄、高血压、GCS 评分、中性粒细胞和 aSKNA。GCS 评分是不良结局的唯一独立危险因素。在 30 天和 1 年随访时，aSKNA 较低的患者预后较差。
ICH 患者的 aSKNA 降低，这可能是一个预后指标。较低的 aSKNA 提示预后较差。本研究数据表明 ECG 信号可能有助于预测 ICH 患者。
