Key result
In patients with sepsis, each one beat per minute increase in maximum heart rate was associated with a 1.3% higher hazard of 28-day mortality (HR 1.013), with both high and low extremes increasing risk.
Why the study?
The effects of maximum heart rate on the prognosis of sepsis patients are still being determined, and an optimal threshold is not yet recommended.
Does maximum heart rate affect 28-day mortality in adult patients with sepsis?
Cohort (n=269)
No
Does maximum heart rate affect 28-day mortality in adult patients with sepsis?
In patients with sepsis, maximum heart rate within 24 hours of ICU admission has a U-shaped relationship with 28-day mortality, with the lowest risk observed between 70 and 110 bpm.
Supports using max heart rate for sepsis mortality risk stratification; hypothesis-generating for rate-targeted interventions.
The effects of maximum heart rate (MHR) on the prognosis of sepsis patients are still being determined, and the most optimal MHR is yet to be recommended. We aimed to determine the association between MHR and 28-day mortality in sepsis patients. A total of 269 patients with sepsis were enrolled in this retrospective cohort study. The patients were all from a 28-bed multi-disciplinary ICU in a tertiary teaching hospital. Relevant information about sepsis patients was extracted according to specific inclusion and exclusion criteria. Examined parameters such as the MHR, blood pressure, laboratory variable, primary disease, and comorbidities were collected. The study outcome was a 28-day death. A Cox proportional hazard model and restricted cubic splines (RCS) were used to elucidate the association between MHR and the 28-day mortality of sepsis patients. Sensitivity analyses were also conducted on our results. Finally, we test and verify our results using a validation cohort from a large public database. In patients with sepsis, the 28-day survivors have the lower MHR than the non-survivors (106 vs. 118, P<0.001). After univariate and multivariate Cox regression analyses, the MHR was significantly correlated with 28-day mortality [hazard ratio 1.013, 95% confidence interval (CI) 1.004-1.022, P = 0.004; hazard ratio 1.013, 95% CI 1.004-1.021, P = 0.004]. The patients in the highest quartile of MHR had a higher risk for 28-day mortality than other patients based on the Kaplan-Meier survival curves (log-rank P<0.001). This correlation remained remarkable in subgroup analysis. A typical U-shaped curve relationship was observed between MHR and the 28-day mortality as a continuous variable using the RCS model. The curve shows that either too high or too low MHR will increase the risk of death. The sepsis patients who had a MHR ranging from approximately 70 to 110 beats per minute (bpm) had the lowest 28-day mortality rate. A similar trend was identified in the validation cohort. High or low MHR was associated with an elevated risk for 28-day mortality in patients with sepsis.
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Shen et al. (2025) conducted a cohort in Sepsis (n=269). Maximum heart rate vs. Lower maximum heart rate was evaluated on 28-day mortality (HR 1.013, 95% CI 1.004-1.021, p=0.004). In patients with sepsis, each one beat per minute increase in maximum heart rate was associated with a 1.3% higher hazard of 28-day mortality (HR 1.013), with both high and low extremes increasing risk.
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