A standard deviation of the NN interval (SDNN) ≤ 17 ms on a 20-minute Holter was associated with a significantly increased risk of 28-day mortality (HR 6.3) in patients with severe sepsis.
Cohort (n=63)
No
Does reduced heart rate variability (specifically SDNN ≤ 17ms) predict 28-day all-cause mortality in adult patients with severe sepsis?
Reduced heart rate variability, specifically an SDNN ≤ 17ms, is a strong and independent predictor of 28-day mortality in patients with severe sepsis, improving predictive power when added to the SOFA score.
Hazard Ratio: 6.3 (95% CI 1.4–28)
p-value: p=0.015
BACKGROUND: Sepsis 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. METHODS: This 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. RESULTS: A 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. CONCLUSIONS: Several 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.
Castilho et al. (2017) conducted a cohort in Severe sepsis (n=63). SDNN ≤ 17ms vs. SDNN > 17ms was evaluated on 28-day all-cause mortality (HR 6.3, 95% CI 1.4-28.0, p=0.015). A standard deviation of the NN interval (SDNN) ≤ 17 ms on a 20-minute Holter was associated with a significantly increased risk of 28-day mortality (HR 6.3) in patients with severe sepsis.