Colleen Badke, MD, MPH
Ann and Robert H Lurie Childrens Hospital of Chicago
Chicago, Illinois
Disclosure information not submitted.
Michael Carroll, PhD
Research Assistant Professor
Ann & Robert H. Lurie Children's Hospital of Chicago, United States
Disclosure information not submitted.
Debra Weese-Mayer, MD
Professor of Pediatrics (Critical Care)
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: Association Between Heart Rate Variability and Inflammatory Biomarkers in Critically Ill Children
Introduction:
The autonomic nervous system can both modulate and be modulated by the inflammatory response during critical illness. Our aim was to determine whether heart rate variability, which is a measure of autonomic nervous system function, is associated with pro-inflammatory biomarker levels in critically ill children.
Methods:
This was an analysis of two cohorts at a single institution. The first was a prospective observational cohort of critically ill children from 2018-2020 who had plasma pro-inflammatory cytokine measurements within 72 hours of admission, including TNF-α, IL-1, IL-6 and IL-8. The second was a retrospective cohort of critically ill children from 2012-2020 who had at least one C-reactive protein (CRP) measurement within 72 hours of admission. Patients in either cohort who had continuous heart rate data available from the bedside monitors were included in the analysis. Heart rate variability (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 was measured in the 12 hours prior to inflammatory biomarker collection. The inflammatory biomarkers were log-transformed prior to analysis.
Results:
Sixty-two patients met inclusion criteria in the prospective cohort and 599 patients in the retrospective cohort. HRVi was inversely correlated with IL-6, IL-8, and CRP levels by Pearson correlation (p≤0.02); correlation with IL-8 persisted after adjusting for PRISM III and age, and median heart rate and age (p< 0.001). There was no correlation with TNF-α or IL-1.
Conclusions:
Heart rate variability is inversely correlated with IL-6, IL-8, and CRP. If validated, heart rate variability could be used as an early, continuous physiologic marker of a pro-inflammatory state in critically ill children.