Key result
A lower SDNN index upon admission was independently associated with an increased risk of an unfavorable prognosis in patients with mild to moderate traumatic brain injury (OR 0.973).
Why the study?
Patients with traumatic brain injury can experience autonomic cardiac dysfunction, prompting evaluation of heart rate variability upon admission to predict prognosis.
Does heart rate variability (SDNN index) upon admission predict unfavorable prognosis in patients with mild to moderate traumatic brain injury?
Cohort (n=172)
No
Does heart rate variability (SDNN index) upon admission predict unfavorable prognosis in patients with mild to moderate traumatic brain injury?
Odds Ratio: 0.973 (95% CI 0.953–0.993)
p-value: p=0.010
Lower heart rate variability (SDNN index) upon admission is an independent predictor of unfavorable prognosis in patients with mild to moderate traumatic brain injury.
Admission SDNN may aid early risk stratification in mild-moderate TBI; hypothesis-generating and requires prospective validation.
INTRODUCTION: Traumatic brain injury (TBI) is a major cause of death and disability in adults. After the injury, patients may experience autonomic dysfunction of the heart, making heart rate variability (HRV) an important factor in predicting their prognosis. This study explored the impact of HRV upon admission on the prognosis of patients with TBI. METHODS: This was a retrospective study that collected clinical data from 172 patients with TBI. Unfavorable prognosis was defined as Glasgow Outcome Scale (GOS) scores < 4, the risk factors were investigated using multivariate logistic regression analysis, and a model for unfavorable prognosis was developed. The prediction value of several models was examined by calculating the area under the receiver operating characteristic (ROC) curve. RESULTS: Among all 172 patients, those with unfavorable prognosis (31 patients) had a lower standard deviation of normal-to-normal (NN) interval (SDNN) index than those with favorable prognosis (65 vs. 86; P = 0.001). The GCS score (OR 0.295, P < 0.001), hemoglobin (OR 0.957, P = 0.002), CK-MB (OR 1.164, P = 0.022), and SDNN index (OR 0.973, P = 0.010) were identified as independent risk variables for unfavorable prognosis using multivariate logistic regression analysis, and they were utilized to build the prognosis model. The area under the ROC curve of the prognosis model was 0.939 (95% confidence interval, 0.898-0.979). CONCLUSION: HRV can be used as an independent predictor of unfavorable prognosis in patients with TBI. Including the SDNN index in prognostic models helps to effectively predict the prognosis of adult patients with TBI. TRIAL REGISTRATION: ClinicalTrial.gov Identifier NCT07024381, retrospectively registered 16 June 2025.
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Wu et al. (2025) conducted a cohort in Mild to moderate Traumatic Brain Injury (TBI) (n=172). Heart rate variability (SDNN index) vs. Higher SDNN index was evaluated on Unfavorable prognosis (Glasgow Outcome Scale score < 4) (OR 0.973, 95% CI 0.953-0.993, p=0.010). A lower SDNN index upon admission was independently associated with an increased risk of an unfavorable prognosis in patients with mild to moderate traumatic brain injury (OR 0.973).
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