Prediction of perioperative complications in colorectal cancer via artificial intelligence analysis of heart rate variability

BackgroundThere is no consensus on the effect of red blood cell transfusion on colorectal cancer (CRC). This study examined the impact of perioperative red blood cell transfusion on postoperative complications, recurrence, and mortality in patients with CRC.MethodsIn this retrospective cohort study, 219 CRC patients admitted to Chongqing Emergency Medical Center, and Chongqing University Central Hospital from 2008 to 2019 were divided into transfusion (n = 75) and non-transfusion (n = 144) groups. Univariate and multivariate Logistic regression analysis were used to analyze the effects of blood transfusion on the severity of postoperative complications in patients with CRC, and univariate and multivariate Cox regression was performed to analyze the effects of blood transfusion on postoperative death and recurrence.ResultsTwenty-two (29.33%) patients in the transfusion group were intermediate or advanced severity of postoperative complications, 31 (41.33%) patients died in the transfusion group, and 55 (73.33%) patients occurred recurrence of the CRC, with the median follow-up time being 24.57(14.50,36.37) months. Our result showed that perioperative red blood cell transfusion was associated with an increased risk of intermediate or advanced severity of postoperative complications in CRC patients [odds ratio (OR) = 3.368, 95% CI, 1.146–9.901]. And perioperative red blood cell transfusion increased the risk of postoperative death [hazard ratio (HR) = 2.747, 95% CI, 1.048–7.205] and recurrence in patients with CRC (HR = 2.168, 95% CI, 1.192–3.943).ConclusionOur finding demonstrated that perioperative red blood cell transfusion was associated with severity of complications, recurrence, and death in CRC patients. However, further studies are still needed to confirm the adverse effects of red blood cell transfusions in CRC patients.

IntroductionRelationships between redox homeostasis, nutritional status, and postoperative complications in patients with colorectal cancer are still unexplained.AimThis study aimed to evaluate selected parameters of oxidative stress and nutritional status in colorectal cancer patients and their impact on postoperative complications.Material and methodsThe study included 50 patients with colorectal cancer. In all patients, body mass index (BMI), body weight loss, and the Nutritional Risk Screening tool (NRS 2002) were assessed. The levels of total protein and albumin, complete blood count (CBC), total antioxidant capacity (TAC), total oxidant status (TOS), and malondialdehyde (MDA) level were measured. Oxidative stress index (OSI) and the TAC/MDA ratio were calculated.ResultsWe detected a significantly higher TAC level (p = 0.0017) and lower TOS level in patients with normal BMI compared to those with increased BMI. We observed a higher TAC level in patients without weight loss (p = 0.0407), whereas the MDA concentration was higher in patients with weight loss than in those without weight loss (p = 0.0025). TAC was significantly higher whereas TOS, OSI, and TAC/MDA ratio were significantly lower in patients without symptoms of malnutrition (p < 0.05). Patients without postoperative complications had higher levels of TOS and MDA, and a lower level of TAC (p < 0.05).ConclusionsThe occurrence of postoperative complications may be associated with increased oxidative stress in patients with colorectal cancer.

Background/Objectives: Colorectal cancer (CRC) is one of the most prevalent malignancies worldwide. Despite advancements in surgical techniques and oncological treatments, postoperative complications remain a significant challenge, affecting both immediate recovery and long-term survival. Systemic inflammation has been identified as a critical factor influencing cancer progression and postoperative outcomes. This systematic review evaluates the clinical significance of blood cell-derived inflammatory markers in predicting early and late postoperative complications in CRC patients. Methods: We included studies involving adult patients (≥18 years) with histologically confirmed colorectal cancer, for whom elective radical surgery was performed, as well as at least one of the considered blood-based inflammatory biomarkers (NLR, PLR, SII, or LMR) documented in relation to outcomes. Results: After removing duplicates, 19 studies published between 2016 and 2025 were included in the qualitative analysis. A total of 7023 patients who underwent elective curative surgery for colorectal cancer were analyzed, with mean age varying widely between 47.3 and 74.6 years. Preoperative NLR values were significantly correlated with severe complications, IAI, AL, and overall complications in 13 out of 19 studies (68.4%), with a cutoff value between 2.21 and 4, while early postoperative NLR values were predictive for AL. Late postoperative complications, such as recurrence and overall survival, were also associated with elevated preoperative NLR and PLR values. However, variability in study designs, patient populations, and cutoff values for these indices contributed to inconsistent findings. Conclusions: Blood cell-derived inflammatory markers offer a valuable, non-invasive tool for assessing postoperative risks in patients with CRC. New design nomograms or risk scores that include, beside blood cell-derived inflammation markers, other relevant data, could ensure an optimal predictive value that could be easily used in clinical practice for personalized risk management in patients with colorectal cancer.

BackgroundRenal function is closely related to cancer prognosis. Since preoperative renal insufficiency has been identified as a risk factor for postoperative complications, this study aimed to investigate the effect of preoperative creatinine clearance rate (CrCl) on short-term prognosis of patients undergoing colorectal surgery.MethodsA retrospective analysis was conducted of the electronic health records of 526 adult patients who underwent elective colorectal cancer (CRC) surgery from September 2014 to February 2019 at the First Affiliated Hospital of Wenzhou Medical University. Cases were divided into two groups according to CrCl level and clinical variables were compared. Risk factors associated with postoperative complications were evaluated through univariate and multivariate logistic regression analyses.ResultsA total of 526 patients met the inclusion criteria. The overall rate of postoperative complications was 28.14%. Overall, the incidence of postoperative complications was significantly higher in the low CrCl patients. A low-level CrCl, multi-organ combined resection, and Charlson comorbidity index (CCI) were independent risk factors for short-term complications in patients with CRC. However, a low CrCl was identified as an independent risk factor for short-term postoperative complications in elderly, but not young patients in a subgroup analysis.ConclusionsPreoperative low-level CrCl, multi-organ combined resection, and CCI were significant risk factors of postoperative complications in CRC patients. Preoperative low-level CrCl and multi-organ combined resection has a poor prognostic impact for elderly patients with CRC. These findings should have important implications for health care decision-making among patients with CRC who are at higher risk for post-operative complications.

To the Editor: We have read the article by Barthel et al1 describing the first prospective trial to determine the predictive value of heart rate turbulence (HRT) in patients after acute myocardial infarction. In previous studies, the ability of HRT to predict risk was only determined retrospectively.2 We would like to critically discuss here the uniqueness of the emerging risk factor, HRT, in comparison with other parameters. Interestingly, Barthel et al1 found that HRT was the strongest ECG-based risk predictor. This conclusion is surprising for 2 reasons, as follows. First, in an editorial comment3 on the original article by Schmidt et al,2 it was noted that the positive predictive value of HRT is only moderately higher than other ECG risk parameters, and it was suggested that …

ABSTRACTBACKGROUND:Although autonomic dysfunction has been shown to be associated with liver cirrhosis, the prevalence and prognostic implications are unclear. Abnormal heart rate variability (HRV), a measure of autonomic function, has not been well investigated in cirrhosis.OBJECTIVE:To evaluate the prevalence of high-risk HRV parameters in a cohort of cirrhotic patients and their association with cardiac dysfunction and mortality.DESIGN AND SETTING:Prospective observational study conducted in the Federal University of São Paulo.METHOD:A cohort of 120 patients, comprising 17 healthy controls and 103 cirrhotic outpatients, was evaluated and followed for 10 months. HRV analysis was based on 24-hour Holter monitoring and defined using time-domain and frequency-domain parameters.RESULTS:The HRV parameters were statistically lower in cirrhotic patients than in healthy subjects. High-risk HRV parameters were prevalent, such that 64% had at least one high-risk parameter. Time-domain parameters correlated with Child scores (P < 0.0001). In regression models, HRV parameters were independent predictors of diastolic dysfunction and mortality. During 10 months of follow-up, there were 11 deaths, all of patients with at least one high-risk HRV parameter. Kaplan-Meier analysis estimated low survival rates among patients with standard deviation of normal-to-normal RR intervals (SDNN) < 100.CONCLUSION:Reduced HRV is prevalent in liver cirrhosis and is related to cardiac dysfunction, severity of liver disease and mortality. Abnormal high-risk HRV parameters are prevalent among cirrhotic patients and are also predictors of mortality. Our findings highlight the need for a more careful cardiac evaluation of cirrhotic patients.

Analysis of heart-rate variability (HRV) is a promising new technique for noninvasive quantification of autonomic function. We measured HRV in patients with severe head injury to assess its potential as a monitoring tool. Analysis of HRV was prospectively done on all intensive care unit patients. Concurrent data on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were collected. Registry data were reviewed to identify patients with severe head injury, defined as Head/Neck Abbreviated Injury Scale score > or = 4. Mortality, likelihood of discharge to home, ICP, and CPP were compared between patients with abnormal HRV and those without. Low HRV was associated with increased mortality and decreased rate of discharge to home. Abnormal HRV was associated with episodes of increased ICP and decreased CPP. Assessment of HRV is a noninvasive method that can be widely used. Abnormal HRV was associated with poor outcome and altered cerebral perfusion. Monitoring of HRV may improve outcome by allowing earlier detection and treatment of intracranial pathology.

Objective: To investigate the incidence of postoperative complications in Chinese patients with gastric or colorectal cancer, and to evaluate the risk factors for postoperative complications. Methods: This was a national, multicenter, prospective, registry-based, cohort study of data obtained from the database of the Prevalence of Abdominal Complications After Gastro- enterological Surgery (PACAGE) study sponsored by the China Gastrointestinal Cancer Surgical Union. The PACAGE database prospectively collected general demographic characteristics, protocols for perioperative treatment, and variables associated with postoperative complications in patients treated for gastric or colorectal cancer in 20 medical centers from December 2018 to December 2020. The patients were grouped according to the presence or absence of postoperative complications. Postoperative complications were categorized and graded in accordance with the expert consensus on postoperative complications in gastrointestinal oncology surgery and Clavien-Dindo grading criteria. The incidence of postoperative complications of different grades are presented as bar charts. Independent risk factors for occurrence of postoperative complications were identified by multifactorial unconditional logistic regression. Results: The study cohort comprised 3926 patients with gastric or colorectal cancer, 657 (16.7%) of whom had a total of 876 postoperative complications. Serious complications (Grade III and above) occurred in 4.0% of patients (156/3926). The rate of Grade V complications was 0.2% (7/3926). The cohort included 2271 patients with gastric cancer with a postoperative complication rate of 18.1% (412/2271) and serious complication rate of 4.7% (106/2271); and 1655 with colorectal cancer, with a postoperative complication rate of 14.8% (245/1655) and serious complication rate of 3.0% (50/1655). The incidences of anastomotic leakage in patients with gastric and colorectal cancer were 3.3% (74/2271) and 3.4% (56/1655), respectively. Abdominal infection was the most frequently occurring complication, accounting for 28.7% (164/572) and 39.5% (120/304) of postoperative complications in patients with gastric and colorectal cancer, respectively. The most frequently occurring grade of postoperative complication was Grade II, accounting for 65.4% (374/572) and 56.6% (172/304) of complications in patients with gastric and colorectal cancers, respectively. Multifactorial analysis identified (1) the following independent risk factors for postoperative complications in patients in the gastric cancer group: preoperative comorbidities (OR=2.54, 95%CI: 1.51-4.28, P<0.001), neoadjuvant therapy (OR=1.42, 95%CI:1.06-1.89, P=0.020), high American Society of Anesthesiologists (ASA) scores (ASA score 2 points:OR=1.60, 95% CI: 1.23-2.07, P<0.001, ASA score ≥3 points:OR=0.43, 95% CI: 0.25-0.73, P=0.002), operative time >180 minutes (OR=1.81, 95% CI: 1.42-2.31, P<0.001), intraoperative bleeding >50 mL (OR=1.29,95%CI: 1.01-1.63, P=0.038), and distal gastrectomy compared with total gastrectomy (OR=0.65,95%CI: 0.51-0.83, P<0.001); and (2) the following independent risk factors for postoperative complications in patients in the colorectal cancer group: female (OR=0.60, 95%CI: 0.44-0.80, P<0.001), preoperative comorbidities (OR=2.73, 95%CI: 1.25-5.99, P=0.030), neoadjuvant therapy (OR=1.83, 95%CI:1.23-2.72, P=0.008), laparoscopic surgery (OR=0.47, 95%CI: 0.30-0.72, P=0.022), and abdominoperineal resection compared with low anterior resection (OR=2.74, 95%CI: 1.71-4.41, P<0.001). Conclusion: Postoperative complications associated with various types of infection were the most frequent complications in patients with gastric or colorectal cancer. Although the risk factors for postoperative complications differed between patients with gastric cancer and those with colorectal cancer, the presence of preoperative comorbidities, administration of neoadjuvant therapy, and extent of surgical resection, were the commonest factors associated with postoperative complications in patients of both categories.

Introduction Parkinsonian syndromes of different nature feature autonomic nervous system dysfunction (ANSd) which may herald or follow motor symptoms (MS) in Parkinson disease (PD), but anticipate by years and progress more rapidly in multiple system atrophy (MSA). Abnormal Heart Rate Variability (HRV) has been reported in both PD and MSA. Purpose This study aimed to evaluating if HRV analysis (HRVa) could contribute to differentiate PD from MSA and to guide early and more appropriate treatment and prognostic assessment. Methods 66 consecutive parkinsonian patients (pts) (48 males, 18 females) (mean age 63.8±10 y) were enrolled between 2010 and 2020. Initial clinical diagnosis was MSA (19), PD (20), PD with autonomic impairment (PD-AI) (10), Lewy body disease (2), supranuclear palsy (3), undefined Parkinsonism (UP) (12). The severity of MS was quantified with UPDRS and Hoehn/Yahr scales. HRV was analyzed with linear (TD and FD) and non-linear (NL) methods (Kubios Premium 3.4.1), during daily activity and NREM sleep (2-minutes intervals) and during REM sleep (1-minute Interval). 44/66 underwent also ASN functional evaluation with the Ewing protocol. Data of 52 age-matched healthy subjects (HS) were used for comparison. For statistical analysis, SPSS software (version 21) was used. Discriminant Analysis (DA) was applied to identify the more relevant parameters differentiating PD from MSA and classifying “undefined” cases. Prolonged follow-up (f-up) provided clinical diagnostic certainty, as goldstandard for validation of HRVa classification accuracy. Results UPDRS and Hoehn/Yahr scores were higher in MSA than in PD (p&amp;lt;0.0001). Along 10-years of f-up, 16/66 pts died (56,2% MSA), 5/66 had new diagnostic definition, and 15/66 were lost to f-up. Most of HRV parameters of 34 pts with certain diagnosis (17 MSA and 17 PD) whose f-up was completed, were significantly different from those of HS. VLFpower and recurrence plot parameters calculated during active wakefulness were different (p&amp;lt;0.05) between MSA and PD, and correctly classified them with 88,2% predictive accuracy (PA) at DA, according to the formula: F1 = (vlfpw%ar* − 0,087) + (rprec* − 0,319) + (rpshen*10.81) + (−20,53) Comparative classification accuracy of HRVa, Ewing score, UPDRS and Hoehn/Yahr scales is shown in Table 1. Attempting prognostic risk assessment by applying F1 to HRV data of pts with PD-AI and of pts with UP, those classified as MSA according to F1 showed the worst clinical outcome during the f-up. Conclusions This study confirms that a higher degree of prevailing sympathetic ASNd in MSA compared to PD can be identified by a combination of Linear and NL HRV parameters, and correctly differentiate with high (88,2%) predictive accuracy all pts with certain diagnosis verified during prolonged f-up. Moreover, HRVa might be useful for earlier prognostic stratification of pts with parkinsonian symptoms of uncertain nature and to improve clinical and pharmacological management. Funding Acknowledgement Type of funding sources: None.

Clinical significance of heart rate variability for the monitoring of cardiac autonomic neuropathy in end-stage renal disease patients

To validate a single-lead ECG fitness tracker device (FT) against the reference multilead ECG recording device (RM) for heart rate (HR) and HR variability (HRV) monitoring of horses during routine swimming. 40 race-fit Thoroughbred racehorses were used for 5 days in May 2024. Surface ECG recordings were obtained simultaneously from the FT and RM devices in horses swimming 63.65 m across a pool. Electrocardiograms were reviewed and artifacts corrected when necessary, and correlations were analyzed between the 2 devices for HR and HRV parameters. Descriptive statistics and Bland-Altman tests were used to determine the agreement between data generated from the 2 devices. A negligible bias was observed for HR (r = 0.99) between the 2 devices. The root mean squared error calculated for HR between them was 0.28 beats/min. The time domain and nonlinear HRV parameters, except triangular index, had additional variability and bias with the FT compared to the RM. This suggests that additional testing is needed to validate the FT for assessment of HRV parameters. The FT and the RM can be used interchangeably for HR monitoring in swimming horses. The FT is not recommended for comprehensive HRV analysis during swimming before bias and variability are corrected. Our findings confirm that the FT is a practical tool to reliably monitor HR in swimming horses, which has applications for fitness and workload monitoring during training.

Office and out of office heart rate measurements: which clinical value?

Heart rate variability (HRV), heart beat-to-beat variations, is a measure of cardiac autonomic functions, and HRV monitoring using sensor technology can be a non-invasive way to assess stress of animals. The objective of this study was to investigate the effect of dietary vitamin A (VA) restriction to enhance beef quality on the physiological status of fattening steers by HRV analysis. Six Japanese Black steers were equally allocated into VA-restricted (RES) and VA-supplemented (SUP) groups. The RES steers were fed VA-restricted diets from 11 to 20 months of age. The inter-beat intervals and blood VA concentration were measured at 18 and 24 months of age. HRV parameters in time, frequency, and non-linear domains were calculated using the inter-beat intervals. Blood VA concentration was significantly lower in RES steers than in SUP steers at 18 months of age (P &amp;lt; 0.05) but did not differ between the groups at 24 months of age. The HRV analysis indicated greater sympathetic and lower parasympathetic activities in RES steers than in SUP steers (P &amp;lt; 0.05). However, there were significant interactions of the group and age on HRV parameters (P &amp;lt; 0.05), indicating that although RES steers at 18 months of age might suffer from slight stress, the response could recover to a level similar to SUP steers at 24 months of age by the increase in blood VA concentration.

BackgroundBurnout is a rising concern among doctors. Heart rate variability (HRV), a non-invasive measure of autonomic nervous system activity, can reflect physiological states of sympathetic (stress) and parasympathetic (recovery) nervous system activity.AimsThis review aims to evaluate how continuous ambulatory HRV monitoring has been used to understand patterns of stress and recovery in doctors.MethodsThe study protocol was preregistered (PROSPERO CRD42023413282). A comprehensive search was conducted. Studies were eligible if they reported at least one HRV parameter combined with at least one contextual or psychological assessment over a 24-hour period in a doctor population. Methodological quality was assessed using the Joanna Briggs Institute risk of bias assessment for case reports and the Standard for Reporting Diagnostic Accuracy in HRV studies STARDHRV.ResultsWe identified 805 records of which seven studies met the inclusion criteria. Meta-analysis was carried out for five different HRV parameters. Studies were conducted in seven different countries, ranged in participant numbers from 12 to 54 and each used a different HRV measurement device. There was a statistically significant difference in HRV between stress and recovery periods with four of these five parameters; root mean square of successive differences SMD = −0.63, P = 0.005, standard deviation of the NN (inter-beat) intervals SMD = −1.05, P = 0.001, low frequency (LF) Standard Mean Difference (SMD) = 0.54, P = 0.01, LF/high frequency (HF) SMD = 0.69, P = 0.006. The quality of studies was moderate at best.ConclusionsContinuous HRV monitoring may offer a viable method for tracking stress and recovery patterns that may contribute to burnout.

BackgroundDecreases in heart rate variability have been shown to be associated with poor outcomes in severe acute brain injury. However, it is unknown whether the changes in heart rate variability precede neurological deterioration in such patients. We explored the changes in heart rate variability measured by electrocardiography in patients who had neurological deterioration following severe acute brain injury, and examined the relationship between heart rate variability and electroencephalography parameters.MethodsRetrospective analysis of 25 patients who manifested neurological deterioration after severe acute brain injury and underwent simultaneous electroencephalography plus electrocardiography monitoring.ResultsEighteen electroencephalography channels and one simultaneously recorded electrocardiography channel were segmented into epochs of 120-second duration and processed to compute 10 heart rate variability parameters and three quantitative electroencephalography parameters. Raw electroencephalography of the epochs was also assessed by standardized visual interpretation and categorized based on their background abnormalities and ictalinterictal continuum patterns. The heart rate variability and electroencephalography parameters showed consistent changes in the 2-day period before neurological deterioration commenced. Remarkably, the suppression ratio and background abnormality of the electroencephalography parameters had significant reverse correlations with all heart rate variability parameters.ConclusionsWe observed a significantly progressive decline in heart rate variability from the day before the neurological deterioration events in patients with severe acute brain injury were first observed.