A time-weighted average heart rate greater than 85 bpm was associated with a significantly increased risk of 28-day mortality (HR 1.92) compared to a heart rate of 85 bpm or less in patients with septic shock.
Cohort (n=13,492)
No
Does maintaining a time-weighted average heart rate ≤ 85 bpm improve 28-day mortality in patients with septic shock?
In patients with septic shock, maintaining a time-weighted average heart rate of 85 bpm or lower during the ICU stay is associated with a significant survival benefit at 28 days.
Hazard Ratio: 1.92 (95% CI 1.78–2.06)
Absolute Event Rate: 26.76% vs 15.14%
p-value: p=<0.001
BACKGROUND: Heart rate is crucial for patients with septic shock, but there are few studies on the scope of heart rate. Therefore, we studied the relationship between different heart rates and mortality of critically ill patients with septic shock, and explored the optimal heart rate range, in order to provide new insights for clinical treatment of septic shock. METHODS: This retrospective study utilized time-series heart rate data from the Medical Information Mart for Intensive Care (MIMIC) IV database. Patients with septic shock were identified as the Sepsis 3.0 criteria and received vasopressor therapy in the first 24 h since ICU admission. We calculated the time-weighted average heart rate (TWA-HR) based on the time-series data. The restricted cubic spline (RCS) analysis was employed to investigate the nonlinear relationship between heart rate and 28-day mortality, aiming to explore the optimal heart rate control target for septic patients and using this target as the exposure factor. The primary outcome was 28-day mortality, and the secondary outcome were ICU and in-hospital mortality. For the original cohort, we applied the log-rank test to infer the relationship between heart rate and mortality. To control for bias introduced by confounders, we utilized propensity score matching (PSM) to reduce imbalances between normal TWA-HR and high TWA-HR groups, and we established a series of models the multivariable Cox model, matching weight (MW)-adjusted Cox model, multivariable logistic regression, MW-adjusted logistic regression, and doubly robust model as sensitivity analyses and subgroup analyses to demonstrate the robustness of our findings. RESULTS: A total of 13492 patients were included in our study. The RCS analysis based on Cox and logistic regression showed increased risk of mortality (P 85 beats per minute (bpm). The log-rank test revealed in terms of the 28-day mortality, the hazard ratio (HR) (95% confidence interval CI) was 1.92 (1.78-2.06, P 85 bpm. CONCLUSION: Patients with septic shock whose heart rate was controlled no more than 85 bpm during ICU stay received survival benefit in terms of 28-day, ICU and in-hospital mortality. .
Ning et al. (2024) conducted a cohort in Septic shock (n=13,492). High time-weighted average heart rate (> 85 bpm) vs. Normal time-weighted average heart rate (≤ 85 bpm) was evaluated on 28-day mortality (HR 1.92, 95% CI 1.78-2.06, p=<0.001). A time-weighted average heart rate greater than 85 bpm was associated with a significantly increased risk of 28-day mortality (HR 1.92) compared to a heart rate of 85 bpm or less in patients with septic shock.