Autonomic Nervous System Dysfunction is Associated with Rehospitalization in Pediatric Septic Shock
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Sepsis, Pediatrics, 2022
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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.
Meta Tag
Content Type Presentation
Knowledge Area Sepsis
Knowledge Area Pediatrics
Knowledge Level Advanced
Membership Level Select
Tag Shock
Tag Pediatrics
Tag Hemodynamic Monitoring
Year 2022
autonomic nervous system dysfunction
pediatric septic shock survivors
heart rate variability


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