• Julio Pontet, Paola Contreras, Andrea Curbelo, Julio Medina, Sylvia Noveri, Solveig Bentancourt, and Eduardo R Migliaro.
• Laboratorio de Fisiología Cardiovascular, Departamento de Fisiología, Facultad de Medicina, Montevideo, Uruguay. erm@fmed.edu.uy
• J Crit Care. 2003 Sep 1; 18 (3): 156-63.

PurposeTo determine whether measuring heart rate variability (HRV) in a group of septic patients without multiple organ dysfunction syndrome (MODS) made it possible to predict which of them would later develop this syndrome.Material And MethodsWe studied 46 septic patients without MODS at the time of admission to an intensive care unit (ICU). During the first 24 hours of admission, a 10-minute electrocardiogram (ECG) was performed and 8 HRV indexes were calculated off-line. Eleven patients later developed MODS (MODS group) during their ICU stay, and 28 did not (non-MODS group). Seven patients were excluded.ResultsAlthough Acute Physiological and Chronic Health Evaluation (APACHE II) scores were similar for both groups, most HRV indices on admission were reduced significantly in the MODS group. Compared with a subset from the non-MODS group (control group, n = 11) paired by age, the MODS group had significantly lower low-frequency spectral components (LF, P =.0128) and mean squared successive differences of R-R intervals (rMSSD) (P =.0473) values. Multivariable logistic regression identified LF as the best predictor of MODS and received operating characteristic (ROC) curves established its cut-off point at 18 ms(2). Mortality rates were 63.6% for the MODS group and 0% for the non-MODS group (P <.0001).ConclusionsReduction of HRV on ICU admission may be useful in identifying septic patients at risk for development of MODS.

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