Altered Heart Rate Variability Early in ICU Admission Differentiates Critically Ill Coronavirus Disease 2019 and All-Cause Sepsis Patients.

• Type of Material: Article
• Authors: Rishikesan Kamaleswaran, Emory University; Ofer Sadan, Emory University; Prem Kandiah, Emory University; Qiao Li, Emory University; Craig Coopersmith, Emory University; Timothy Buchman, Emory University
• Language: English
• Date: 2021-12
• Publisher: Wolters Kluwer Health, Inc
• Publication Version: Final Published Version
• Copyright Statement: © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1097/CCE.0000000000000570
• Title of Journal or Parent Work: Crit Care Explor
• Volume: 3
• Issue: 12
• Start Page: e0570
• End Page: e0570
• Grant/Funding Information: Supported, in part, by grant from the Surgical Critical Care Initiative, funded through the Department of Defense’s Health Program—Joint Program Committee 6/Combat Casualty Care (USUHS HT9404-13-1-0032 and HU0001-15-2-0001).; Dr. Kamaleswaran was supported by the National Institute of General Medical Sciences under award number R01GM139967 and the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH) under UL1TR002378. Dr. Coopersmith was supported by funding from the NIH (GM072808, GM104323, AA027396, and GM139967). The remaining authors have disclosed that they do not have any potential conflicts of interest.
• Keywords: decompensation; heart rate variability; coronavirus disease 2019; sepsis; severe acute respiratory syndrome coronavirus 2
• Research Categories: Biology, Virology

Abstract

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.