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Cited by 195Sepsis Diagnosis and TreatmentHeart Rate Variability and Autonomic ControlHemodynamic Monitoring and Therapy

Heart rate variability as early marker of multiple organ dysfunction syndrome in septic patients

Pontet, Julio, Contreras, Paola, Curbelo, Andrea, Medina, Julio, Noveri, Sylvia, Bentancourt, Solveig, Migliaro, Eduardo R.·2003·Journal of Critical Care
DOI 10.1016/j.jcrc.2003.08.005
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Abstract

Purpose 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.Material and 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.

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  • Patients with sepsis and organ failure have increased cytokine levels.

    “Cholinergic and anticholinergic drugs are also widely used in intensive care units, where patients with sepsis and organ failure have increased cytokine levels and depressed vagus nerve activity (55,56,(81)(82)(83).”

    From Physiology and immunology of the cholinergic antiinflammatory pathway (2007) · cites this paper as [56]

  • Patients with sepsis and organ failure have depressed vagus nerve activity.

    “Cholinergic and anticholinergic drugs are also widely used in intensive care units, where patients with sepsis and organ failure have increased cytokine levels and depressed vagus nerve activity (55,56,(81)(82)(83).”

    From Physiology and immunology of the cholinergic antiinflammatory pathway (2007) · cites this paper as [56]

  • Depressed vagus nerve activity is significantly correlated with increased morbidity and mortality in sepsis, rheumatoid arthritis, lupus, sarcoidosis, inflammatory bowel diseases, other diseases, and trauma.

    “Clinical research implicates a significant correlation between depressed vagus nerve activity and increased morbidity and mortality in sepsis, rheumatoid arthritis, lupus, sarcoidosis, inflammatory bowel diseases, other diseases, and trauma (55)(56)(57)(58)(59)(60)(61)(62)(63).”

    From Physiology and immunology of the cholinergic antiinflammatory pathway (2007) · cites this paper as [56]

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Authors
Pontet, J., Contreras, P., Curbelo, A., Medina, J., Noveri, S., Bentancourt, S., & Migliaro, E. R.
Affiliations
  • Universidad de la República de Uruguay (UY)
  • Institut Pasteur de Montevideo (UY)
Corresponding author
Migliaro, Eduardo R.
ORCID
Venue
Journal of Critical Care
Publisher
Elsevier BV
Published
2003-09
Volume
18
Issue
3
Pages
156-163
ISSN
0883-9441 (ISSN-L)
DOI
10.1016/j.jcrc.2003.08.005
OpenAlex
W2056503107
Cited by
195
References
50
Citations by year
2026: 4 · 2025: 4 · 2024: 10 · 2023: 5 · 2022: 8 · 2021: 11 · 2020: 9 · 2019: 6 · 2018: 9 · 2017: 14 · 2016: 5 · 2015: 9 · 2014: 9 · 2013: 11 · 2012: 17
FWCI
3.51
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of Critical Care (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
  • Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
Keywords
heart rate variability, multiple organ failure, sepsis, RMSSD, APACHE II score, mortality, intensive care unit admission
MeSH terms
Adult, Aged, Electrocardiography, Female, Heart Rate, Humans, Intensive Care Units, Male, Middle Aged, Multiple Organ Failure, Predictive Value of Tests, Prospective Studies, Retrospective Studies, ROC Curve, Biomarkers, Logistic Models, Case-Control Studies, Sepsis

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