Association Between Heart Rate Variability and Inflammatory Biomarkers in Critically Ill Children


Author: Colleen M Badke1, Michael S Carroll, Debra E Weese-Mayer, L Nelson Sanchez-Pinto

Affiliation: <sup>1</sup> Division of Critical Care Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL. Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL. Department of Pediatrics, Stanley Manne Children's Research Institute, Chicago, IL. Data Analytics and Reporting, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL. Division of Autonomic Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
Conference/Journal: Pediatr Crit Care Med
Date published: 2022 Mar 16
Other:
  Special Notes: doi: 10.1097/PCC.0000000000002936.   ,  Word Count: 246  
    Objectives:

The autonomic nervous system (ANS) can both modulate and be modulated by the inflammatory response during critical illness. We aimed to determine whether heart rate variability (HRV), a measure of ANS function, is associated with proinflammatory biomarker levels in critically ill children.



Design:

Two cohorts were analyzed. The first was a prospective observational cohort from August 2018 to August 2020 who had plasma proinflammatory cytokine measurements within 72 hours of admission, including tumor necrosis factor-α, interleukin (IL)-1β, IL-6, and IL-8. The second was a retrospective cohort from June 2012 to August 2020 who had at least one C-reactive protein (CRP) measurement within 72 hours of admission.



Setting:

Forty-six-bed PICU.



Patients:

Critically ill children in either cohort who had continuous heart rate data available from the bedside monitors.



Interventions:

None.



Measurements and main results:

Sixty-two patients were included in the prospective cohort and 599 patients in the retrospective cohort. HRV was measured using the age-adjusted integer heart rate variability (HRVi), which is the SD of the heart rate sampled every 1 second over 5 consecutive minutes. The median HRVi was measured in the 12-hour period ending 30 minutes prior to inflammatory biomarker collection. HRVi was inversely correlated with IL-6, IL-8, and CRP levels (p ≤ 0.02); correlation with IL-8 and CRP persisted after adjusting for Pediatric Risk of Mortality III and age, and median HR and age (p < 0.001).



Conclusions:

HRVi is inversely correlated with IL-6, IL-8, and CRP. Further studies are needed to validate this measure as a proxy for a proinflammatory state.





PMID: 35293369 DOI: 10.1097/PCC.0000000000002936