Early heart rate variability evaluation enables to predict ICU patients' outcome

Laetitia Bodenes, Quang-Thang N'Guyen, Raphaël Le Mao, Nicolas Ferrière, Victoire Pateau, François Lellouche, Erwan L'Her, Laetitia Bodenes, Quang-Thang N'Guyen, Raphaël Le Mao, Nicolas Ferrière, Victoire Pateau, François Lellouche, Erwan L'Her

Abstract

Heart rate variability (HRV) is a mean to evaluate cardiac effects of autonomic nervous system activity, and a relation between HRV and outcome has been proposed in various types of patients. We attempted to evaluate the best determinants of such variation in survival prediction using a physiological data-warehousing program. Plethysmogram tracings (PPG) were recorded at 75 Hz from the standard monitoring system, for a 2 h period, during the 24 h following ICU admission. Physiological data recording was associated with metadata collection. HRV was derived from PPG in either the temporal and non-linear domains. 540 consecutive patients were recorded. A lower LF/HF, SD2/SD1 ratios and Shannon entropy values on admission were associated with a higher ICU mortality. SpO2/FiO2 ratio and HRV parameters (LF/HF and Shannon entropy) were independent correlated with mortality in the multivariate analysis. Machine-learning using neural network (kNN) enabled to determine a simple decision tree combining the three best determinants (SDNN, Shannon Entropy, SD2/SD1 ratio) of a composite outcome index. HRV measured on admission enables to predict outcome in the ICU or at Day-28, independently of the admission diagnosis, treatment and mechanical ventilation requirement.Trial registration: ClinicalTrials.gov identifier NCT02893462.

Conflict of interest statement

All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr. Bodenes declares she has no conflict of interest related to this research. Mr N Guyen declares he has no conflict of interest related to this research. Dr Le mao declares he has no conflict of interest related to this research. Dr Ferriere declares he has no conflict of interest related to this research. Pr. L’Her is a consultant for GE healthcare, Sedana Medical, Smiths and Archeon. He is a co-inventor of the FreeO2 patent, cofounder and shareholder of Oxynov Inc. that commercializes FreeO2. Pr Lelouche has received research funding from Fisher Paykel and Hamilton Medical and received honorarium for consultancy from Oxynov. Ms Pateau was financed by research grant from Oxynov Inc. as a research assistant.

© 2022. The Author(s).

Figures

Figure 1
Figure 1
Decision tree for outcome evaluation following admission in the ICU. NN normal interbeat, SD1 standard deviation 1, SD2 standard deviation 2, SD2/SD1 ratio SD2/SD1, SDNN standard deviation of NN, Bad a bad outcome was defined as either death and/or any form of respiratory assistance and/or a median ICU stay higher than the median, Favorable a favorable outcome was defined as the occurrence of none of the previous adverse events.

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