Combining Heart Rate Variability with Disease Severity Score Variables for Mortality Risk Stratification in Septic Patients Presenting at the Emergency Department

Abstract

The emergency department (ED) serves as the first point of hospital contact for many septic patients, where risk-stratification would be invaluable. We devised a combination model incorporating demographic, clinical, and heart rate variability (HRV) parameters, alongside individual variables of the Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation II (APACHE II), and Mortality in Emergency Department Sepsis (MEDS) scores for mortality risk-stratification. ED patients fulfilling systemic inflammatory response syndrome criteria were recruited. National Early Warning Score (NEWS), Modified Early Warning Score (MEWS), quick SOFA (qSOFA), SOFA, APACHE II, and MEDS scores were calculated. For the prediction of 30-day in-hospital mortality, combination model performed with an area under the receiver operating characteristic curve of 0.91 (95% confidence interval (CI): 0.88–0.95), outperforming NEWS (0.70, 95% CI: 0.63–0.77), MEWS (0.61, 95% CI 0.53–0.69), qSOFA (0.70, 95% CI 0.63–0.77), SOFA (0.74, 95% CI: 0.67–0.80), APACHE II (0.76, 95% CI: 0.69–0.82), and MEDS scores (0.86, 95% CI: 0.81–0.90). The combination model had an optimal sensitivity and specificity of 91.4% (95% CI: 81.6–96.5%) and 77.9% (95% CI: 72.6–82.4%), respectively. A combination model incorporating clinical, HRV, and disease severity score variables showed superior predictive ability for the mortality risk-stratification of septic patients presenting at the ED.

National Early Warning Score Does Not Accurately Predict Mortality for Patients With Infection Outside the Intensive Care Unit: A Systematic Review and Meta-Analysis

“…In addition, when we restricted analysis to studies (19-24, 26, 28, 31, 32, 34-38) that evaluated the NEWS at admission or excluded five studies with small sample sizes (20,24,27,31,32), the sensitivity analyses showed similar results to the primary result.…”

“…These studies recruited a total of 107,008 participants, and the mortality rate in each study ranged from 2.5 to 32.8%. Five studies (20,24,27,31,32) were relatively small in sample size (<400), and 10 studies (19, 23, 26, 28-30, 33, 36, 37, 40) enrolled more than 1,000 patients. Ten studies (19,21,22,(27)(28)(29)(32)(33)(34)(35) included patients with suspected infection, and others focused on patients with suspected sepsis.…”

The Association of Autonomic Nervous System Function With Ischemic Stroke, and Treatment Strategies

“…The HRV-based classifier could identify hypertensive patients at high risk of developing vascular events with high sensitivity and specificity (71.4 and 87.8%, respectively) (51). A combination model incorporating HRV and other disease severity score variables showed optimal predictive ability of 30-day in-hospital mortality for septic patients at the emergency department against conventional risk stratification tools (AUC = 0.91, 95% confidence interval: 0.88-0.95) (52,53). The exploitation of HRV in risk stratification tools of stroke becomes one of the vital and prophylactic measures for high-risk individuals to ring alarm bells.…”

Heart rate n-variability (HRnV) measures for prediction of mortality in sepsis patients presenting at the emergency department

“…Being a non-invasive tool that can be rapidly obtained even from patients who are unable to give a history, HRV has been shown to be dysregulated in sepsis [ 13 ] and correlates well with subsequent mortality [ 14 , 15 ]. Indeed, scoring systems that incorporate HRV parameters among its predictors have outperformed traditional clinical indicators and established disease severity scores in predicting sepsis mortality [ 16 – 19 ]. The use of HRV may thus further enhance our ability to stratify for risk of sepsis mortality.…”