Spectral analysis of heart period and pulse transit time derived from electrocardiogram and photoplethysmogram in sepsis patients

Hing, Tang Howe; Grace, Clare; Middleton, Paul; Savkin, Andrey V.; Lovell, Nigel H.

doi:10.1109/iembs.2009.5334005

Cited by 10 publications

(7 citation statements)

References 17 publications

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“…Heart rate variability (HRV) measures oscillations of the intervals between consecutive heart beats, being therefore a noninvasive indirect test to evaluate autonomic function [ 11 ]. Studies have shown that patients with sepsis have reduced HRV compared to healthy patients[ 12 , 13 ]. Ahmad et al demonstrated, in a small study, that patients with sepsis showed a significant drop in the value of several HRV parameters on average 35 hours before the diagnosis of sepsis[ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Heart rate variability as predictor of mortality in sepsis: A systematic review

et al. 2018

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BackgroundAutonomic dysregulation is one of the recognized pathophysiological mechanisms in sepsis, generating the hypothesis that heart rate variability (HRV) can be used to predict mortality in sepsis.MethodsThis was a systematic review of studies evaluating HRV as a predictor of death in patients with sepsis. The search was performed by independent researchers in PubMed, LILACS and Cochrane, including papers in English, Portuguese or Spanish, indexed until August 20th, 2017 with at least 10 patients. Study quality was assessed by Newcastle-Ottawa Scale. To analyze the results, we divided the articles between those who measured HRV for short-term recordings (≤ 1 hour), and those who did long-term recordings (≥ 24 hours).ResultsNine studies were included with a total of 536 patients. All of them were observational studies. Studies quality varied from 4 to 7 stars in Newcastle-Ottawa Scale. The mortality rate in the studies ranged from 8 to 61%. Seven studies performed HRV analysis in short-term recordings. With the exception of one study that did not explain which group had the lowest results, all other studies showed reduction of several HRV parameters in the non-survivors in relation to the surviving septic patients. SDNN (Standard deviation of the Normal to Normal interval), TP (Total Power), VLF (Very Low Frequency Power), LF (Low Frequency Power), LF/HF (Low Frequency Power / High Frequency Power), nLF (Normalized Low Frequency Power), α1/α2 (short-term and long-term fractal scaling coefficients from DFA) and r-MSSD (Square root of the squared mean of the difference of successive NN-intervals) of the non-survivor group were reduced in relation to the survivors in at least one study. Two studies found that SDNN is associated with mortality in sepsis, even after adjusting for possible confounding factors. Three studies performed HRV analysis using long-term recordings. Only one of these studies found difference between surviving and non-surviving groups, and even so, in only one HRV parameter: LogHF.ConclusionsSeveral HRV parameters are reduced in nonsurviving septic patients in short-term recording. Two studies have found that SDNN is associated with mortality in sepsis, even after adjusting for possible confounding factors.

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Section: Introductionmentioning

confidence: 99%

Heart rate variability as predictor of mortality in sepsis: A systematic review

et al. 2018

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“…HRV measures the oscillation of the intervals between consecutive heart beats, which are related to, the influences of the autonomic nervous system on the sinus node[6]. Patients with sepsis have reduced HRV compared to healthy patients, as demonstrated in small studies[7–9]. Furthermore, HRV parameters such as low frequency (LF) power are positively correlated with APACHE II and SOFA[10] and negatively correlated with interleukins[11].…”

Section: Introductionmentioning

confidence: 99%

Heart rate variability as predictor of mortality in sepsis: A prospective cohort study

et al. 2017

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BackgroundSepsis is a serious medical condition with increasing prevalence and high mortality. The role of the autonomic nervous system in pathophysiology of sepsis has been increasingly researched. The objective of this study is to evaluate the Heart rate variability (HRV) as a predictor of mortality in septic patients.MethodsThis was a prospective cohort of patients diagnosed with sepsis. Patient recruitment was carried out at ICU in tertiary university hospital between March 2012 and February 2014. Clinical data and laboratory exams were collected at admission. Each patient underwent a 20-minute Holter and a 24-hour Holter on the first day of enrollment. The primary outcome was the 28-day all-cause mortality.ResultsA total of 63 patients were included. Patients were categorized into nonsurvivor group (n = 16) or survivor group (n = 47) depending on this endpoint. Survivors were younger (48.6 years vs. 63.0 years), had better renal function and lower values in severity scores (APACHE II and SOFA) compared to nonsurvivors. In the 20-minute Holter, SDNN, Total Power, VLF Power, LF Power and LF/HF of nonsurvivors were significantly lower than those of survivors (p = <0.001, p = 0.003, p = 0.002, p = 0.006, p = 0.009 respectively). ROC curve of SDNN was built, showing area under the curve of 0.772 (0.638–0.906) for mortality. The value of 17ms was chosen as best SDNN cutoff to discriminate survivors and nonsurvivors. In the Cox proportional regression, adjusted for SOFA score and for APACHE II, a SDNN ≤ 17ms was associated with a greater risk of death, with hazard ratios of 6.3 (1.4–28.0; p = 0.015) and 5.5 (1,2–24,8; p = 0.027), respectively. The addition of the dichotomized SDNN to the SOFA model reduced AIC and increased the concordance statistic and the R2, indicating that predictive power of the SDNN + SOFA model is better than predictive power of SOFA only.ConclusionsSeveral HRV parameters are reduced in nonsurviving septic patients. SDNN ≤17 is a risk factor for death in septic patients, even after adjusting for severity scores.

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“…This results in decreased heart rate variability (HRV), changes in heart rate, and conduction delays (176)(177)(178). Reduced HRV has been associated with unfavorable outcomes in sepsis (179,180). In septic rodents, treatment with exogenous oxytocin restores the normal heart rate values, and favors cardiac pacemaker coupling with cholinergic influences.…”

Section: Cardiovascular Systemmentioning

confidence: 99%

Oxytocin and Related Peptide Hormones: Candidate Anti-Inflammatory Therapy in Early Stages of Sepsis

et al. 2022

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Sepsis is a potentially life-threatening systemic inflammatory syndrome characterized by dysregulated host immunological responses to infection. Uncontrolled immune cell activation and exponential elevation in circulating cytokines can lead to sepsis, septic shock, multiple organ dysfunction syndrome, and death. Sepsis is associated with high re-hospitalization and recovery may be incomplete, with long term sequelae including post-sepsis syndrome. Consequently, sepsis continues to be a leading cause of morbidity and mortality across the world. In our recent review of human chorionic gonadotropin (hCG), we noted that its major properties including promotion of fertility, parturition, and lactation were described over a century ago. By contrast, the anti-inflammatory properties of this hormone have been recognized only more recently. Vasopressin, a hormone best known for its anti-diuretic effect, also has anti-inflammatory actions. Surprisingly, vasopressin’s close cousin, oxytocin, has broader and more potent anti-inflammatory effects than vasopressin and a larger number of pre-clinical studies supporting its potential role in limiting sepsis-associated organ damage. This review explores possible links between oxytocin and related octapeptide hormones and sepsis-related modulation of pro-inflammatory and anti-inflammatory activities.

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Spectral analysis of heart period and pulse transit time derived from electrocardiogram and photoplethysmogram in sepsis patients

Cited by 10 publications

References 17 publications

Heart rate variability as predictor of mortality in sepsis: A systematic review

Heart rate variability as predictor of mortality in sepsis: A systematic review

Heart rate variability as predictor of mortality in sepsis: A prospective cohort study

Oxytocin and Related Peptide Hormones: Candidate Anti-Inflammatory Therapy in Early Stages of Sepsis

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