IDEAS home Printed from https://ideas.repec.org/a/gam/jijerp/v16y2019i10p1725-d231644.html
   My bibliography  Save this article

Combining Heart Rate Variability with Disease Severity Score Variables for Mortality Risk Stratification in Septic Patients Presenting at the Emergency Department

Author

Listed:
  • Jeremy Zhenwen Pong

    (Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore)

  • Stephanie Fook-Chong

    (Health Services Research Unit, Singapore General Hospital, Singapore 169608, Singapore)

  • Zhi Xiong Koh

    (Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore)

  • Mas’uud Ibnu Samsudin

    (General Medicine, Ministry of Health Holdings, Singapore 099253, Singapore)

  • Takashi Tagami

    (Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo 206-8512, Japan)

  • Calvin J. Chiew

    (Preventive Medicine Residency Program, National University Health System, Singapore 119228, Singapore)

  • Ting Hway Wong

    (Department of General Surgery, Singapore General Hospital, Singapore 169608, Singapore)

  • Andrew Fu Wah Ho

    (Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore)

  • Marcus Eng Hock Ong

    (Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore
    Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore)

  • Nan Liu

    (Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore
    Health Services Research Centre, Singapore Health Services, Singapore 169856, Singapore)

Abstract

The emergency department (ED) serves as the first point of hospital contact for many septic patients, where risk-stratification would be invaluable. We devised a combination model incorporating demographic, clinical, and heart rate variability (HRV) parameters, alongside individual variables of the Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation II (APACHE II), and Mortality in Emergency Department Sepsis (MEDS) scores for mortality risk-stratification. ED patients fulfilling systemic inflammatory response syndrome criteria were recruited. National Early Warning Score (NEWS), Modified Early Warning Score (MEWS), quick SOFA (qSOFA), SOFA, APACHE II, and MEDS scores were calculated. For the prediction of 30-day in-hospital mortality, combination model performed with an area under the receiver operating characteristic curve of 0.91 (95% confidence interval (CI): 0.88–0.95), outperforming NEWS (0.70, 95% CI: 0.63–0.77), MEWS (0.61, 95% CI 0.53–0.69), qSOFA (0.70, 95% CI 0.63–0.77), SOFA (0.74, 95% CI: 0.67–0.80), APACHE II (0.76, 95% CI: 0.69–0.82), and MEDS scores (0.86, 95% CI: 0.81–0.90). The combination model had an optimal sensitivity and specificity of 91.4% (95% CI: 81.6–96.5%) and 77.9% (95% CI: 72.6–82.4%), respectively. A combination model incorporating clinical, HRV, and disease severity score variables showed superior predictive ability for the mortality risk-stratification of septic patients presenting at the ED.

Suggested Citation

  • Jeremy Zhenwen Pong & Stephanie Fook-Chong & Zhi Xiong Koh & Mas’uud Ibnu Samsudin & Takashi Tagami & Calvin J. Chiew & Ting Hway Wong & Andrew Fu Wah Ho & Marcus Eng Hock Ong & Nan Liu, 2019. "Combining Heart Rate Variability with Disease Severity Score Variables for Mortality Risk Stratification in Septic Patients Presenting at the Emergency Department," IJERPH, MDPI, vol. 16(10), pages 1-14, May.
    • Handle: RePEc:gam:jijerp:v:16:y:2019:i:10:p:1725-:d:231644
    as

    Download full text from publisher

    File URL: https://www.mdpi.com/1660-4601/16/10/1725/pdf
    Download Restriction: no
    File URL: https://www.mdpi.com/1660-4601/16/10/1725/
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Sumanth Madhusudan Prabhakar & Takashi Tagami & Nan Liu & Mas’uud Ibnu Samsudin & Janson Cheng Ji Ng & Zhi Xiong Koh & Marcus Eng Hock Ong, 2019. "Combining quick sequential organ failure assessment score with heart rate variability may improve predictive ability for mortality in septic patients at the emergency department," PLOS ONE, Public Library of Science, vol. 14(3), pages 1-11, March.
    2. Fábio M de Castilho & Antonio Luiz P Ribeiro & José Luiz P da Silva & Vandack Nobre & Marcos R de Sousa, 2017. "Heart rate variability as predictor of mortality in sepsis: A prospective cohort study," PLOS ONE, Public Library of Science, vol. 12(6), pages 1-15, June.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Yuzhe Liu & Jody Manners & Yazan Bittar & Sherry H-Y Chou & Vanathi Gopalakrishnan, 2019. "Towards precision critical care management of blood pressure in hemorrhagic stroke patients using dynamic linear models," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-28, August.
    2. Sumanth Madhusudan Prabhakar & Takashi Tagami & Nan Liu & Mas’uud Ibnu Samsudin & Janson Cheng Ji Ng & Zhi Xiong Koh & Marcus Eng Hock Ong, 2019. "Combining quick sequential organ failure assessment score with heart rate variability may improve predictive ability for mortality in septic patients at the emergency department," PLOS ONE, Public Library of Science, vol. 14(3), pages 1-11, March.
    3. Fábio M de Castilho & Antonio Luiz P Ribeiro & Vandack Nobre & Guilherme Barros & Marcos R de Sousa, 2018. "Heart rate variability as predictor of mortality in sepsis: A systematic review," PLOS ONE, Public Library of Science, vol. 13(9), pages 1-13, September.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:gam:jijerp:v:16:y:2019:i:10:p:1725-:d:231644. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: MDPI Indexing Manager (email available below). General contact details of provider: https://www.mdpi.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.