• John E Arbo, Jeremy K Lessing, William J H Ford, Sunday Clark, Eli Finkelsztein, Edward J Schenck, Rahul Sharma, and Paul M Heerdt.
• Department of Emergency Medicine, Weill Medical College of Cornell University, New York, NY, United States of America; Division of Pulmonary and Critical Care Medicine, Weill Medical College of Cornell University, New York, NY, United States of America; Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY, United States of America. Electronic address: arboj1@nychhc.org.
• Am J Emerg Med. 2020 Dec 1; 38 (12): 260726132607-2613.

IntroductionThis study evaluates the utility of heart rate variability (HRV) for assessment of severity of illness and poor outcome in Emergency Department (ED) patients with sepsis. HRV measures evaluated included low frequency (LF) signal, high frequency (HF) signal, and deviations in LF and HF signal from age-adjusted reference values.MethodsThis was a prospective, observational study. Seventy-two adult ED patients were assessed within 6 h of arrival.ResultsSeverity of illness as defined by sepsis subtype correlated with decreased LF signal (sepsis: 70.68 ± 22.95, severe sepsis: 54.00 ± 28.41, septic shock: 45.54 ± 23.31, p = 0.02), increased HF signal (sepsis: 27.87 ± 19.42, severe sepsis: 44.63 ± 27.29, septic shock: 47.66 ± 20.98, p = 0.01), increasingly negative deviations in LF signal (sepsis: 0.41 ± 24.53, severe sepsis: -21.43 ± 30.09, septic shock -30.39 ± 26.09, p = 0.005) and increasingly positive deviations in HF signal (sepsis: -1.86 ± 21.09, severe sepsis: 20.07 ± 29.03, septic shock: 23.6 ± 24.17, p = 0.004). Composite poor outcome correlated with decreased LF signal (p = 0.008), increased HF signal (p = 0.03), large negative deviations in LF signal (p = 0.004) and large positive deviations in HF signal (p = 0.02). Deviations in LF and HF signal from age-adjusted reference values correlated with individual measures of poor outcome with greater consistency than LF or HF signal.DiscussionAccounting for the influence of age on baseline HRV signal improves the predictive value of HRV measures in ED patients with sepsis.Copyright © 2020 Elsevier Inc. All rights reserved.

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