Key result
The multi-scale symbolic entropy parameter Slope 5 was significantly associated with death or urgent cardiac transplantation (HR 0.031) and improved the prognostic predictive power of conventional clinical severity scores in patients receiving extracorporeal life support.
Why the study?
Does multi-scale symbolic entropy analysis (MSsE) improve prognostic prediction of death or urgent transplantation in patients receiving extracorporeal life support?
Observational (n=80)
No
Does multi-scale symbolic entropy analysis (MSsE) improve prognostic prediction of death or urgent transplantation in patients receiving extracorporeal life support?
Hazard Ratio: 0.031 (95% CI 0.003–0.306)
p-value: p=0.003
Multi-scale symbolic entropy analysis (MSsE), particularly the slope 5 parameter, provides significant additional prognostic information for predicting mortality or urgent transplantation in patients receiving extracorporeal life support when combined with conventional clinical severity scores.
May refine risk prediction when added to clinical scores in ECLS; hypothesis-generating and requires prospective validation before practice change.
INTRODUCTION: Extracorporeal life support (ECLS) can temporarily support cardiopulmonary function, and is occasionally used in resuscitation. Multi-scale entropy (MSE) derived from heart rate variability (HRV) is a powerful tool in outcome prediction of patients with cardiovascular diseases. Multi-scale symbolic entropy analysis (MSsE), a new method derived from MSE, mitigates the effect of arrhythmia on analysis. The objective is to evaluate the prognostic value of MSsE in patients receiving ECLS. The primary outcome is death or urgent transplantation during the index admission. METHODS: Fifty-seven patients receiving ECLS less than 24 hours and 23 control subjects were enrolled. Digital 24-hour Holter electrocardiograms were recorded and three MSsE parameters (slope 5, Area 6-20, Area 6-40) associated with the multiscale correlation and complexity of heart beat fluctuation were calculated. RESULTS: Patients receiving ECLS had significantly lower value of slope 5, area 6 to 20, and area 6 to 40 than control subjects. During the follow-up period, 29 patients met primary outcome. Age, slope 5, Area 6 to 20, Area 6 to 40, acute physiology and chronic health evaluation II score, multiple organ dysfunction score (MODS), logistic organ dysfunction score (LODS), and myocardial infarction history were significantly associated with primary outcome. Slope 5 showed the greatest discriminatory power. In a net reclassification improvement model, slope 5 significantly improved the predictive power of LODS; Area 6 to 20 and Area 6 to 40 significantly improved the predictive power in MODS. In an integrated discrimination improvement model, slope 5 added significantly to the prediction power of each clinical parameter. Area 6 to 20 and Area 6 to 40 significantly improved the predictive power in sequential organ failure assessment. CONCLUSIONS: MSsE provides additional prognostic information in patients receiving ECLS.
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Lin et al. (2014) conducted an observational in Circulatory or respiratory failure requiring extracorporeal life support (n=80). Multi-scale symbolic entropy analysis (MSsE) parameter Slope 5 was evaluated on Death or urgent cardiac transplantation during the index admission (HR 0.031, 95% CI 0.003-0.306, p=0.003). The multi-scale symbolic entropy parameter Slope 5 was significantly associated with death or urgent cardiac transplantation (HR 0.031) and improved the prognostic predictive power of conventional clinical severity scores in patients receiving extracorporeal life support.
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