Heart/breathing rate ratio (HBR) as a predictor of mortality in critically ill patients

ObjectivesThe early prediction of death is a challenge for medical staff. We evaluated the ability of the heart/breathing rate ratio (HBR) to predict mortality.MethodsThis was a single-center retrospective observational study of adult patients who had fever with or without respiratory symptoms, who survived at least 2 hours after visiting the hospital, and whose lactate levels and vital signs were tested. We evaluated the distribution of mortality at different HBR levels and compared HBR with lactate.ResultsA total of 18 872 fever clinic visits were screened, and 183 patients whose lactate levels were tested were recruited. Patients who had HBR values lower than 4·5 or higher than 5·5 had greater mortality than patients who had HBR values between 4·5 and 5·5 (21·3% vs. 3·4%, p=0·003; 28·9% vs. 3·4%, p<0·001, respectively). In patients whose HBR was <5, the AUROC for HBR for mortality was 0·762 (95% CI: 0.643–0·880), and that for lactate was 0·701 (95% CI: 0·564–0·837). In patients whose HBR was ≥5, the AUROC for HBR for mortality was 0·721 (95% CI: 0·584–0·857), and that for lactate was 0·742 (95% CI: 0·607–0·848).ConclusionsHBR is helpful for stratifying mortality risk among critically ill patients in acute care clinics for infectious diseases.