title: Heart rate before ICU discharge: a simple and readily available predictor of short- and long-term mortality from critical illness.
abstract: OBJECTIVE
  A heart rate >90 bpm serves as one of four characteristics defining the systemic inflammatory response syndrome and is used in scoring systems to predict in-hospital mortality of intensive care unit (ICU) patients. Despite its central role in critical illness, specific data regarding the relationship between heart rate and outcome are rare.
  
  
  METHODS
  In this post hoc analysis of a prospectively collected database, we analyzed the value of heart rate averaged from four predefined time points during the last 24 h before ICU discharge as a predictor of post-ICU in-hospital and post-hospital mortality in medical ICU patients. Furthermore, the relationship between heart rate and inflammation, as well as the influence of rate control medications on the association between heart rate and outcome were identified.
  
  
  RESULTS
  Among the 702 ICU patients discharged from the ICU, 7.1 % died before hospital discharge. At 4 years of follow-up, post-hospital mortality was 14.4 %. Multivariate Cox proportional hazards models revealed heart rate before ICU discharge (HR 5.95; 95 % CI 1.24-28.63; p = 0.03) as an independent predictor of post-ICU in-hospital mortality. Both heart rate (HR 2.56; 95 % CI, 1.05-6.34; p = 0.04) and the C-reactive protein serum concentration before ICU discharge (HR, 1.26; 95 % CI, 1.09-1.46; p = 0.002) were independently associated with post-hospital mortality. Heart rate control therapy reduced the risk of post-ICU in-hospital (HR 0.38; 95 % CI, 0.18-0.81; p = 0.01) and post-hospital (HR, 0.47; 95 % CI, 0.22-1.00; p = 0.05) mortality.
  
  
  CONCLUSIONS
  Heart rate evaluated 24 h before ICU discharge was independently associated with post-ICU in-hospital and post-hospital mortality. Pharmacological interventions to control heart rate may beneficially influence post-ICU mortality.
authors.affiliation: Department of Internal Medicine, Academic Teaching Hospital Hall in Triol, Milserstrasse 10, 6060, Hall in Tirol, Austria. wilhelm.grander@tilak.at
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Grander
authors.forename: Kathrin
authors.initials: K
authors.lastname: Müllauer
authors.forename: Bernhard
authors.initials: B
authors.lastname: Koller
authors.forename: Herbert
authors.initials: H
authors.lastname: Tilg
authors.forename: Martin
authors.initials: M
authors.lastname: Dünser
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism; D016638:Critical Illness / Q000401:mortality*; D016208:Databases, Factual; D005500:Follow-Up Studies; D006339:Heart Rate; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D002097:C-Reactive Protein