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Heart rate variability as early marker of multiple organ dysfunction syndrome in septic patients
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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“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]
In the citing paper
“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]
In the citing paper
“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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Metadata
- 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.
- Venue
- Journal of Critical Care
- Publisher
- Elsevier BV
- Published
- 2003-09
- Volume
- 18
- Issue
- 3
- Pages
- 156-163
- ISSN
- 0883-9441 (ISSN-L)
- 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
- Locations
- Journal of Critical Care (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › 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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