Komaenthammasophon Chalermchai, Pachinburavan Monvasi, Chokesuwattanaskul Ronpichai
Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand.
Division of Cardiology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand.
Heliyon. 2024 Jul 17;10(15):e34842. doi: 10.1016/j.heliyon.2024.e34842. eCollection 2024 Aug 15.
Heart rate variability (HRV) has prognostic value for predicting mortality in both cardiovascular and sepsis patients. Decreased HRV has been associated with increased mortality and morbidity. However, the prognostic significance of HRV in critically ill patients COVID-19 pneumonia still remains unknown. The current study aimed to (1) evaluate prognostic utility of HRV parameters on outcomes in patients with severe COVID-19 pneumonia and (2) assess the correlation between HRV parameters and inflammatory markers.
Consecutive critically ill patients with COVID-19 pneumonia admitted to a tertiary referral intensive care unit from October 2021 to June 2022 in Bangkok, Thailand were enrolled. HRV parameters over the 24 h following intensive care unit admission were recorded using telemetry and analyzed using the Holter program (Philips Holter 2010 Plus/1810 Series). Receiver-operating characteristic (ROC) curve analysis was used to determine optimum threshold cutoffs of various HRV parameters. Formal comparisons of in-hospital mortality between patients with and without a decrease in HRV were performed using Cox regression after adjusting for potential confounders.
A total of 65 patients were enrolled in the study. Patients were classified into two groups: survivors (n = 44, 68 %) and non-survivors (n = 21, 32 %). The standard deviation of normal-to-normal intervals (SDNN) was significantly lower in non-survivors than in survivors (70.30 vs. 105.95; p = 0.03). The SDNN predicted in-hospital mortality with an area under the ROC curve of 0.67 (95 % CI 0.55-0.79). At a cutoff of 70 ms, the SDNN showed a sensitivity and specificity of 0.48 and 0.86. The low SDNN group (<70 ms) demonstrated higher median ferritin, IL-6, and hs-C-reactive protein levels than did the normal SDNN group, although such differences did not reach statistical significance (1139.0 vs. 508.4; p = 0.137 and 91.2 vs. 64.4; p = 0.352, respectively). After adjusting for potential confounders in the multivariable model, the adjusted hazard ratio for in-hospital mortality in those with SDNN <70 ms was 3.70 (95 % CI 1.34-10.24).
A decrease in SDNN, a commonly used HRV parameter, was associated with mortality and inflammatory biomarkers in critically ill patients with COVID-19 pneumonia.
心率变异性（HRV）对预测心血管疾病患者和脓毒症患者的死亡率具有预后价值。HRV降低与死亡率和发病率增加有关。然而，HRV在重症新型冠状病毒肺炎患者中的预后意义仍不清楚。本研究旨在：（1）评估HRV参数对重症新型冠状病毒肺炎患者预后的预测作用；（2）评估HRV参数与炎症标志物之间的相关性。
纳入2021年10月至2022年6月期间在泰国曼谷一家三级转诊重症监护病房收治的连续性重症新型冠状病毒肺炎患者。使用遥测技术记录重症监护病房入院后24小时内的HRV参数，并使用动态心电图程序（飞利浦动态心电图2010 Plus/1810系列）进行分析。采用受试者工作特征（ROC）曲线分析来确定各种HRV参数的最佳阈值。在调整潜在混杂因素后，使用Cox回归对HRV降低和未降低的患者的院内死亡率进行正式比较。
本研究共纳入65例患者。患者分为两组：幸存者（n = 44，68%）和非幸存者（n = 21，32%）。非幸存者的正常到正常间期标准差（SDNN）显著低于幸存者（70.30对105.95；p = 0.03）。SDNN预测院内死亡率的ROC曲线下面积为0.67（95%CI 0.55 - 0.79）。在阈值为70毫秒时，SDNN的敏感性和特异性分别为0.48和0.86。低SDNN组（<70毫秒）的铁蛋白、IL - 6和高敏C反应蛋白水平中位数高于正常SDNN组，尽管这些差异未达到统计学意义（分别为1139.0对508.4；p = 0.137和91.2对64.4；p = 0.352）。在多变量模型中调整潜在混杂因素后，SDNN <70毫秒的患者院内死亡的调整后风险比为3.70（95%CI 1.34 - 10.24）。
常用的HRV参数SDNN降低与重症新型冠状病毒肺炎患者的死亡率及炎症生物标志物有关。
