TY - JOUR
T1 - Autonomic impairment of patients in coma with different Glasgow coma score assessed with heart rate variability
AU - Estévez-Báez, Mario
AU - Machado, Calixto
AU - García-Sánchez, Benjamín
AU - Rodríguez, Valia
AU - Alvarez-Santana, Reynaldo
AU - Leisman, Gerry
AU - Carrera, José Mario Estévez
AU - Schiavi, Adam
AU - Montes-Brown, Julio
AU - Arrufat-Pié, Eduardo
N1 - Publisher Copyright:
© 2019, © 2019 Taylor & Francis Group, LLC.
PY - 2019/3/21
Y1 - 2019/3/21
N2 - Primary objective: The objective of this study is to assess the functional state of the autonomic nervous system in healthy individuals and in individuals in coma using measures of heart rate variability (HRV) and to evaluate its efficiency in predicting mortality. Design and Methods: Retrospective group comparison study of patients in coma classified into two subgroups, according to their Glasgow coma score, with a healthy control group. HRV indices were calculated from 7 min of artefact-free electrocardiograms using the Hilbert–Huang method in the spectral range 0.02–0.6 Hz. A special procedure was applied to avoid confounding factors. Stepwise multiple regression logistic analysis (SMLRA) and ROC analysis evaluated predictions. Results: Progressive reduction of HRV was confirmed and was associated with deepening of coma and a mortality score model that included three spectral HRV indices of absolute power values of very low, low and very high frequency bands (0.4-0.6 Hz). The SMLRA model showed sensitivity of 95.65%, specificity of 95.83%, positive predictive value of 95.65%, and overall efficiency of 95.74%. Conclusions: HRV is a reliable method to assess the integrity of the neural control of the caudal brainstem centres on the hearts of patients in coma and to predict patient mortality.
AB - Primary objective: The objective of this study is to assess the functional state of the autonomic nervous system in healthy individuals and in individuals in coma using measures of heart rate variability (HRV) and to evaluate its efficiency in predicting mortality. Design and Methods: Retrospective group comparison study of patients in coma classified into two subgroups, according to their Glasgow coma score, with a healthy control group. HRV indices were calculated from 7 min of artefact-free electrocardiograms using the Hilbert–Huang method in the spectral range 0.02–0.6 Hz. A special procedure was applied to avoid confounding factors. Stepwise multiple regression logistic analysis (SMLRA) and ROC analysis evaluated predictions. Results: Progressive reduction of HRV was confirmed and was associated with deepening of coma and a mortality score model that included three spectral HRV indices of absolute power values of very low, low and very high frequency bands (0.4-0.6 Hz). The SMLRA model showed sensitivity of 95.65%, specificity of 95.83%, positive predictive value of 95.65%, and overall efficiency of 95.74%. Conclusions: HRV is a reliable method to assess the integrity of the neural control of the caudal brainstem centres on the hearts of patients in coma and to predict patient mortality.
KW - Glasgow coma scale
KW - Heart rate variability
KW - Hilbert–Huang transform
KW - autonomic nervous system
KW - coma
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U2 - 10.1080/02699052.2018.1553312
DO - 10.1080/02699052.2018.1553312
M3 - Article
C2 - 30755043
AN - SCOPUS:85061783801
SN - 0269-9052
VL - 33
SP - 496
EP - 516
JO - Brain Injury
JF - Brain Injury
IS - 4
ER -