Heart rate variability as early marker of multiple organ dysfunction syndrome in septic patients.
OBJECTIVE
To determine whether measuring heart rate variability (HRV) in a group of septic patients without multiple organ dysfunction syndrome (MODS) made it possible to predict which of them would later develop this syndrome.


METHODS
We studied 46 septic patients without MODS at the time of admission to an intensive care unit (ICU). During the first 24 hours of admission, a 10-minute electrocardiogram (ECG) was performed and 8 HRV indexes were calculated off-line. Eleven patients later developed MODS (MODS group) during their ICU stay, and 28 did not (non-MODS group). Seven patients were excluded.


RESULTS
Although Acute Physiological and Chronic Health Evaluation (APACHE II) scores were similar for both groups, most HRV indices on admission were reduced significantly in the MODS group. Compared with a subset from the non-MODS group (control group, n = 11) paired by age, the MODS group had significantly lower low-frequency spectral components (LF, P =.0128) and mean squared successive differences of R-R intervals (rMSSD) (P =.0473) values. Multivariable logistic regression identified LF as the best predictor of MODS and received operating characteristic (ROC) curves established its cut-off point at 18 ms(2). Mortality rates were 63.6% for the MODS group and 0% for the non-MODS group (P <.0001).


CONCLUSIONS
Reduction of HRV on ICU admission may be useful in identifying septic patients at risk for development of MODS.
Laboratorio de Fisiología Cardiovascular, Departamento de Fisiología, Facultad de Medicina, Montevideo, Uruguay. erm@fmed.edu.uy
Julio
J
Pontet
Paola
P
Contreras
Andrea
A
Curbelo
Julio
J
Medina
Sylvia
S
Noveri
Solveig
S
Bentancourt
Eduardo R
ER
Migliaro
D000328:Adult; D000368:Aged; D015415:Biomarkers; D016022:Case-Control Studies; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000175:diagnosis* / Q000209:etiology* / Q000401:mortality; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications* / Q000503:physiopathology*
D015415:Biomarkers