Abstract
BackgroundHeart rate (HR) related parameters, such as HR variability, HR turbulence, resting HR, and nighttime mean HR have been recognized as independent predictors of mortality. However, the influence of circadian changes in HR on mortality remains unclear in intensive care units (ICU). The study is designed to evaluate the relationship between the circadian variation in HR and mortality risk among critically ill patients.MethodsThe present study included 4,760 patients extracted from the Multiparameter Intelligent Monitoring in Intensive Care II database. The nighttime mean HR/daytime mean HR ratio was adopted as the circadian variation in HR. According to the median value of the circadian variation in HR, participants were divided into two groups: group A (≤ 1) and group B (> 1). The outcomes included ICU, hospital, 30-day, and 1-year mortalities. The prognostic value of HR circadian variation was investigated by multivariable logistic regression models and Cox proportional hazards models.ResultsPatients in group B (n = 2,471) had higher mortality than those in group A (n = 2,289). Multivariable models revealed that the higher circadian variation in HR was associated with ICU mortality (odds ratio [OR], 1.393; 95% confidence interval [CI], 1.112–1.745; P = 0.004), hospital mortality (OR, 1.393; 95% CI, 1.112–1.745; P = 0.004), 30-day mortality (hazard ratio, 1.260; 95% CI, 1.064–1.491; P = 0.007), and 1-year mortality (hazard ratio, 1.207; 95% CI, 1.057–1.378; P = 0.005), especially in patients with higher SOFA scores.ConclusionsThe circadian variation in HR might aid in the early identification of critically ill patients at high risk of associated with ICU, hospital, 30-day, and 1-year mortalities.
Highlights
Heart rate (HR) related parameters, such as HR variability, HR turbulence, resting HR, and nighttime mean HR have been recognized as independent predictors of mortality
Sex, and ethnicity were included in the demographics and clinical diseases were diagnosed according to the International Classification of Diseases-9 diagnoses (ICD, 9th Editor), which includes respiratory failure, renal failure, liver cirrhosis, shock, diabetes uncomplicated, diabetes complicated, acquired immune deficiency syndrome (AIDS), lymphoma, metastatic cancer, coagulopathy, rheumatoid arthritis, infection, poisoning, hypoferric anemia, and a series of cardiovascular diseases
Interaction analysis Considering the Sequential Organ Failure Assessment (SOFA) score to be a strong predictor of mortality in intensive care units (ICU) patients, the interaction effect between the circadian variation of HR and the SOFA score was analyzed
Summary
Heart rate (HR) related parameters, such as HR variability, HR turbulence, resting HR, and nighttime mean HR have been recognized as independent predictors of mortality. The study is designed to evaluate the relationship between the circadian variation in HR and mortality risk among critically ill patients. Heart rate (HR) is regulated by the autonomic nervous system, and the autonomic nervous system function could be reflected by HR variations, such as heart rate variability (HRV), heart rate turbulence (HRT), resting heart rate (RHR), and nighttime mean heart rate (NHR). HRT describes the physiological short-term oscillation of beatto-beat intervals after spontaneous ventricular premature beats [12], which has been introduced as an autonomic predictor for cardiac mortality following myocardial infarction or heart failure [12, 13]. The above parameters have been verified to have a higher predictive value for mortality, they either have their own limitations or ignore the circadian rhythm of the HR
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