Prognostic value of variables derived from heart rate variability in patients with traumatic brain injury after decompressive surgery.

Abstract

Measurement of heart rate variability can reveal autonomic nervous system function. Changes in heart rate variability can be associated with disease severity, risk of complications, and prognosis. We aimed to investigate the prognostic value of heart rate variability measurements in patients with moderate-to-severe traumatic brain injury after decompression surgery. We conducted a prospective study of 80 patients with traumatic brain injury after decompression surgery using a noninvasive electrocardiography device for data collection. Assessment of heart rate variability parameters included the time and frequency domains. The correlations between heart rate variability parameters and one-year mortality and functional outcomes were analyzed. Time domain measures of heart rate variability, using the standard deviation of the RR intervals and the square root of the mean squared differences of successive RR intervals, were statistically significantly lower in the group of patients with unfavorable outcomes and those that died. In frequency domain analysis, very low-frequency and total power were significantly higher in patients with favorable functional outcomes. High-frequency, low-frequency, and total power were statistically significantly higher in patients who survived for more than one year. Multivariate analysis using a model combining age and the Glasgow Coma Scale score with variables derived from heart rate variability substantially improved the prognostic value for predicting long-term outcome. These findings reinforced the concept that traumatic brain injury impacts the brain-heart axis and cardiac autonomic modulation even after decompression surgery, and variables derived from heart rate variability may be useful predictors of outcome.