title: Autonomic dysfunction predicts both 1- and 2-month mortality in middle-aged patients with multiple organ dysfunction syndrome.
abstract: OBJECTIVE
  Multiple organ dysfunction syndrome (MODS) is a disease entity that carries a high mortality rate. It is characterized by a sequential failure of several organ systems after a trigger event, most commonly sepsis. There is increasing evidence that autonomic dysfunction may substantially contribute to the development of MODS. We recently characterized the spectrum of autonomic dysfunction by using heart rate variability in critically ill MODS patients and were able to show that autonomic dysfunction predicts 28-day mortality in MODS. The aim of the present study was evaluate whether autonomic dysfunction is also a predictor of 180-day and 365-day mortalities.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Twelve-bed medical intensive care unit in a university center.
  
  
  METHODS
  Ninety consecutively admitted score-defined MODS patients.
  
  
  METHODS
  We assessed heart rate variability as a marker of autonomic dysfunction. The patients were followed for 180- and 365-day mortalities.
  
  
  RESULTS
  We prospectively used the heart rate variability variable lnVLF, which predicted 28-day mortality best in the entire cohort of patients, for analysis of longer term mortality. The variable lnVLF was found to be useful for risk prediction for about 60 days, and then the survival curves became nearly parallel.
  
  
  CONCLUSIONS
  Autonomic function of critically ill MODS patients is blunted, and this attenuation has prognostic implications not merely concerning 28-day mortality but also concerning longer term (about 2-month) mortality.
authors.affiliation: Martin-Luther-University Halle-Wittenberg, Germany. hendrik.schmidt@medizin.uni-halle.de
authors.forename: Hendrik
authors.initials: H
authors.lastname: Schmidt
authors.forename: Dirk
authors.initials: D
authors.lastname: Hoyer
authors.forename: Ralf
authors.initials: R
authors.lastname: Hennen
authors.forename: Konstantin
authors.initials: K
authors.lastname: Heinroth
authors.forename: Mathias
authors.initials: M
authors.lastname: Rauchhaus
authors.forename: Roland
authors.initials: R
authors.lastname: Prondzinsky
authors.forename: Kuno
authors.initials: K
authors.lastname: Hottenrott
authors.forename: Michael
authors.initials: M
authors.lastname: Buerke
authors.forename: Ursula
authors.initials: U
authors.lastname: Müller-Werdan
authors.forename: Karl
authors.initials: K
authors.lastname: Werdan
mesh_terms: D001341:Autonomic Nervous System / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality* / Q000503:physiopathology*; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors