OasisLMS

INTRODUCTION: Re-hospitalization after septic shock can lead to impaired quality of life. Predictors of re-hospitalization may identify sepsis survivors at high-risk for re-hospitalization. Our goal was to determine whether low heart rate variability (HRV), a measure of autonomic nervous system dysfunction, is associated with re-hospitalization in pediatric septic shock survivors.  METHODS: This was a retrospective, observational cohort study of patients admitted to a single pediatric intensive care unit (PICU) between 2012-2020. Patients with septic shock who had continuous heart rate data available from bedside monitors and survived their hospitalization were included. HRV was measured using the age-adjusted integer HRV (HRVi), which is the standard deviation of the heart rate sampled every 1 second over 5 consecutive minutes and age-normalized. The median HRVi in 24 hours was assessed on two different days: the last 24 hours of PICU admission (“last HRVi”) and the 24-hour period with the lowest median HRVi (“lowest HRVi”). The change between the lowest and last HRVi was calculated (“delta HRVi”). The primary outcome was re-hospitalization to the same institution within 365 days of discharge, including both emergency department encounters and hospital readmission. Kruskal-Wallis tests, logistic regression, and Poisson regression were performed.  RESULTS: 463 patients met inclusion criteria. 306 (66%) were re-hospitalized, including 270 readmissions (58%). The median last HRVi was significantly lower among re-hospitalized patients compared to those who were not (-0.35, interquartile range [IQR] -0.63-0.01 vs. -0.22, IQR -0.52-0.06, p = 0.016). There was no difference in the lowest HRVi. Re-hospitalized patients showed a smaller improvement in delta HRVi compared to those who were not (0.44, IQR 0.13-0.84 vs. 0.58, IQR 0.22-1.03, p = 0.024). This association remained significant after adjusting for age, severity of illness using PRISM III, immunocompromised state, and technology dependence.  CONCLUSIONS: Lower discharge HRV and a smaller improvement in HRV during admission are significantly associated with re-hospitalization in survivors of pediatric septic shock. This continuous physiologic measure could potentially be used as a predictor of patients at risk for re-hospitalization and lower quality of life.