Tricia Pendergrast, BA
Medical Student
Ann & Robert H. Lurie Children's Hospital
Chicago, Illinois
Disclosure information not submitted.
Catherine A Chapin, MD
Attending Physician, Division of Gastroenterology, Hepatology & Nutrition
Ann & Robert H. Lurie Children's Hospital of Chicago, United States
Disclosure information not submitted.
Alyssa Kriegermeier, MD
Attending Physician, Gastroenterology, Hepatology and Nutrition
Ann & Robert H. Lurie Children's Hospital of Chicago, Illinois, United States
Disclosure information not submitted.
Andrea Pardo, MD
Attending Physician, Neurology Associate Professor of Pediatrics (Neurology and Epilepsy)
Ann & Robert H. Lurie Children's Hospital of Chicago, United States
Disclosure information not submitted.
Lee Bass, MD
Associate Professor of Pediatrics (Gastroenterology, Hepatology, and Nutrition)
Ann & Robert H. Lurie Children's Hospital of Chicago, United States
Disclosure information not submitted.
L. Nelson Sanchez-Pinto, MD, MBI
Assistant Professor of Pediatrics (Critical Care)
Ann & Robert H. Lurie Children's Hospital of Chicago
Chicago, Illinois
Disclosure information not submitted.
Title: Heart Rate Variability: A Physiologic Marker of Encephalopathy in Children with Liver Failure
INTRODUCTION/HYPOTHESIS: Hepatic encephalopathy (HE) is a known determinant of outcomes in pediatric acute liver failure (PALF), but early and accurate recognition of neurologic dysfunction is difficult in children. Heart rate variability (HRV), a noninvasive, readily-available, and continuous measure of autonomic nervous system function could serve as a physiologic marker of HE in children with PALF. We hypothesized that lower HRV was associated with higher HE severity and worse patient outcomes in children with PALF.
Methods: We conducted a retrospective study of children with PALF admitted to the PICU between 1/2013-12/2020 at Lurie Children’s Hospital of Chicago. PALF was defined using standard criteria and patients were stratified into patients with favorable and unfavorable outcomes (died or were listed for transplant). The integer HRV (HRVi) was calculated as the age-normalized standard deviation of heart rate in beats-per-minute measured every second over a five-minute time window. The minimum and median HRVi were compared at 6, 12, and 24 hours between patient groups using t-tests after testing for normality of the data distribution.
Results: Thirty-eight children met criteria for inclusion: 57.9% were female, and 14 patients died or listed for transplant. There were no significant differences in sex, age, ethnicity, race, or etiology of liver failure between groups. Patients with Grade III or IV HE had significantly more negative minimum and median HRVi measurements at hours 6, 12, and 24 (p < 0.001). The patient group with unfavorable outcomes (died or listed for transplant) had significantly more negative minimum HRVi at hour 12 (p = 0.02) and significantly more negative median HRVi at hours 6, 12, and 24, (p < 0.001)
Conclusions: Decreased heart rate variability was significantly associated with worse outcomes in patients with PALF. Future studies are needed to determine whether HRV monitoring may play a role in predicting which patients are more likely to need liver transplantation to survive and which patients may recover with their native liver.