Altered Heart Rate Variability Early in ICU Admission Differentiates Critically Ill Coronavirus Disease 2019 and All-Cause Sepsis Patients
IMPORTANCE:. Altered heart rate variability has been associated with autonomic dysfunction in a number of disease profiles, in this work we elucidate differences in the biomarker among patients with all-cause sepsis and coronavirus disease 2019. OBJECTIVES:. To measure heart rate variability metrics...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2021-12-01
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| Series: | Critical Care Explorations |
| Online Access: | http://journals.lww.com/10.1097/CCE.0000000000000570 |
| _version_ | 1818987743711068160 |
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| author | Rishikesan Kamaleswaran, PhD Ofer Sadan, MD Prem Kandiah, MD Qiao Li, PhD Craig M. Coopersmith, MD Timothy G. Buchman, MD, PhD |
| author_facet | Rishikesan Kamaleswaran, PhD Ofer Sadan, MD Prem Kandiah, MD Qiao Li, PhD Craig M. Coopersmith, MD Timothy G. Buchman, MD, PhD |
| author_sort | Rishikesan Kamaleswaran, PhD |
| collection | DOAJ |
| description | IMPORTANCE:. Altered heart rate variability has been associated with autonomic dysfunction in a number of disease profiles, in this work we elucidate differences in the biomarker among patients with all-cause sepsis and coronavirus disease 2019.
OBJECTIVES:. To measure heart rate variability metrics in critically ill coronavirus disease 2019 patients with comparison to all-cause critically ill sepsis patients.
DESIGN, SETTING, AND PARTICIPANTS:. Retrospective analysis of coronavirus disease 2019 patients admitted to an ICU for at least 24 hours at any of Emory Healthcare ICUs between March 2020 and April 2020 up to 5 days of ICU stay. The comparison group was a cohort of all-cause sepsis patients prior to coronavirus disease 2019 pandemic.
MAIN OUTCOMES AND MEASURES:. Continuous waveforms were captured from the patient monitor. The electrocardiogram was then analyzed for each patient over a 300 seconds observational window that was shifted by 30 seconds in each iteration from admission till discharge. A total of 23 heart rate variability metrics were extracted in each iteration. We use the Kruskal-Wallis and Steel-Dwass tests (p < 0.05) for statistical analysis and interpretations of heart rate variability multiple measures.
RESULTS:. A total of 141 critically ill coronavirus disease 2019 patients met inclusion criteria, who were compared with 208 patients with all-cause sepsis. Three nonlinear markers, including the ratio of standard deviation derived from the Poincaré plot, sample entropy, and approximate entropy and four linear features, including mode of beat-to-beat interval, acceleration capacity, deceleration capacity, and the proportion of consecutive RR intervals that differ by more than 50 ms, were all statistically significant (p < 0.05) between the coronavirus disease 2019 and all-cause sepsis cohorts. The three nonlinear features and acceleration capacity, deceleration capacity, and beat-to-beat interval (mode) were statistically significant (p < 0.05) when comparing pairwise analysis among the combinations of survivors and nonsurvivors between the coronavirus disease 2019 and sepsis cohorts. Temporal analysis of the main markers showed low variability across the 5 days of analysis compared with sepsis patients.
CONCLUSIONS AND RELEVANCE:. In this descriptive statistical study, heart rate variability measures were found to be statistically different across critically ill patients infected with severe acute respiratory syndrome coronavirus 2 and distinct from bacterial sepsis. |
| first_indexed | 2024-12-20T19:11:33Z |
| format | Article |
| id | doaj.art-67d07ad83a734e2785ed0396adbb2a3e |
| institution | Directory Open Access Journal |
| issn | 2639-8028 |
| language | English |
| last_indexed | 2024-12-20T19:11:33Z |
| publishDate | 2021-12-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Critical Care Explorations |
| spelling | doaj.art-67d07ad83a734e2785ed0396adbb2a3e2022-12-21T19:29:12ZengWolters KluwerCritical Care Explorations2639-80282021-12-01312e057010.1097/CCE.0000000000000570202112000-00001Altered Heart Rate Variability Early in ICU Admission Differentiates Critically Ill Coronavirus Disease 2019 and All-Cause Sepsis PatientsRishikesan Kamaleswaran, PhD0Ofer Sadan, MD1Prem Kandiah, MD2Qiao Li, PhD3Craig M. Coopersmith, MD4Timothy G. Buchman, MD, PhD51 Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA.3 Emory Critical Care Center, Emory University School of Medicine, Atlanta, GA.3 Emory Critical Care Center, Emory University School of Medicine, Atlanta, GA.1 Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA.3 Emory Critical Care Center, Emory University School of Medicine, Atlanta, GA.1 Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA.IMPORTANCE:. Altered heart rate variability has been associated with autonomic dysfunction in a number of disease profiles, in this work we elucidate differences in the biomarker among patients with all-cause sepsis and coronavirus disease 2019. OBJECTIVES:. To measure heart rate variability metrics in critically ill coronavirus disease 2019 patients with comparison to all-cause critically ill sepsis patients. DESIGN, SETTING, AND PARTICIPANTS:. Retrospective analysis of coronavirus disease 2019 patients admitted to an ICU for at least 24 hours at any of Emory Healthcare ICUs between March 2020 and April 2020 up to 5 days of ICU stay. The comparison group was a cohort of all-cause sepsis patients prior to coronavirus disease 2019 pandemic. MAIN OUTCOMES AND MEASURES:. Continuous waveforms were captured from the patient monitor. The electrocardiogram was then analyzed for each patient over a 300 seconds observational window that was shifted by 30 seconds in each iteration from admission till discharge. A total of 23 heart rate variability metrics were extracted in each iteration. We use the Kruskal-Wallis and Steel-Dwass tests (p < 0.05) for statistical analysis and interpretations of heart rate variability multiple measures. RESULTS:. A total of 141 critically ill coronavirus disease 2019 patients met inclusion criteria, who were compared with 208 patients with all-cause sepsis. Three nonlinear markers, including the ratio of standard deviation derived from the Poincaré plot, sample entropy, and approximate entropy and four linear features, including mode of beat-to-beat interval, acceleration capacity, deceleration capacity, and the proportion of consecutive RR intervals that differ by more than 50 ms, were all statistically significant (p < 0.05) between the coronavirus disease 2019 and all-cause sepsis cohorts. The three nonlinear features and acceleration capacity, deceleration capacity, and beat-to-beat interval (mode) were statistically significant (p < 0.05) when comparing pairwise analysis among the combinations of survivors and nonsurvivors between the coronavirus disease 2019 and sepsis cohorts. Temporal analysis of the main markers showed low variability across the 5 days of analysis compared with sepsis patients. CONCLUSIONS AND RELEVANCE:. In this descriptive statistical study, heart rate variability measures were found to be statistically different across critically ill patients infected with severe acute respiratory syndrome coronavirus 2 and distinct from bacterial sepsis.http://journals.lww.com/10.1097/CCE.0000000000000570 |
| spellingShingle | Rishikesan Kamaleswaran, PhD Ofer Sadan, MD Prem Kandiah, MD Qiao Li, PhD Craig M. Coopersmith, MD Timothy G. Buchman, MD, PhD Altered Heart Rate Variability Early in ICU Admission Differentiates Critically Ill Coronavirus Disease 2019 and All-Cause Sepsis Patients Critical Care Explorations |
| title | Altered Heart Rate Variability Early in ICU Admission Differentiates Critically Ill Coronavirus Disease 2019 and All-Cause Sepsis Patients |
| title_full | Altered Heart Rate Variability Early in ICU Admission Differentiates Critically Ill Coronavirus Disease 2019 and All-Cause Sepsis Patients |
| title_fullStr | Altered Heart Rate Variability Early in ICU Admission Differentiates Critically Ill Coronavirus Disease 2019 and All-Cause Sepsis Patients |
| title_full_unstemmed | Altered Heart Rate Variability Early in ICU Admission Differentiates Critically Ill Coronavirus Disease 2019 and All-Cause Sepsis Patients |
| title_short | Altered Heart Rate Variability Early in ICU Admission Differentiates Critically Ill Coronavirus Disease 2019 and All-Cause Sepsis Patients |
| title_sort | altered heart rate variability early in icu admission differentiates critically ill coronavirus disease 2019 and all cause sepsis patients |
| url | http://journals.lww.com/10.1097/CCE.0000000000000570 |
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