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

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 and Nan Liu
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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
Nan Liu: Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore

IJERPH, 2019, vol. 16, issue 10, 1-14

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.

Keywords: heart rate variability; sepsis; mortality; prediction; emergency department (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2019
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