Autonomic impairment of patients in coma with different Glasgow coma score assessed with heart rate variability

Mario Estévez-báez, Calixto Machado, Benjamín García-sánchez, Valia Rodríguez, Reynaldo Alvarez-santana, Gerry Leisman, José Mario Estévez Carrera, Adam Schiavi, Julio Montes-brown, Eduardo Arrufat-pié

Research output: Contribution to journalArticle

Abstract

Primary objective: The objective of this study is to assess the functional state of the autonomic nervous system in healthy individuals and in individuals in coma using measures of heart rate variability (HRV) and to evaluate its efficiency in predicting mortality. Design and Methods: Retrospective group comparison study of patients in coma classified into two subgroups, according to their Glasgow coma score, with a healthy control group. HRV indices were calculated from 7 min of artefact-free electrocardiograms using the Hilbert–Huang method in the spectral range 0.02–0.6 Hz. A special procedure was applied to avoid confounding factors. Stepwise multiple regression logistic analysis (SMLRA) and ROC analysis evaluated predictions. Results: Progressive reduction of HRV was confirmed and was associated with deepening of coma and a mortality score model that included three spectral HRV indices of absolute power values of very low, low and very high frequency bands (0.4-0.6 Hz). The SMLRA model showed sensitivity of 95.65%, specificity of 95.83%, positive predictive value of 95.65%, and overall efficiency of 95.74%. Conclusions: HRV is a reliable method to assess the integrity of the neural control of the caudal brainstem centres on the hearts of patients in coma and to predict patient mortality.
Original languageEnglish
Pages (from-to)496-516
Number of pages21
JournalBrain Injury
Volume33
Issue number4
Early online date12 Feb 2019
DOIs
Publication statusPublished - 21 Mar 2019

Fingerprint

Coma
Heart Rate
Mortality
Regression Analysis
Autonomic Nervous System
ROC Curve
Artifacts
Brain Stem
Electrocardiography
Logistic Models
Sensitivity and Specificity
Control Groups

Bibliographical note

This is an Accepted Manuscript of an article published by Taylor & Francis Group in Brain Injury on 12 Feb 2019, available online at: http://www.tandfonline.com/10.1080/02699052.2018.1553312

Keywords

  • autonomic nervous system
  • coma
  • Glasgow coma scale
  • Heart rate variability
  • Hilbert–Huang transform

Cite this

Estévez-báez, M., Machado, C., García-sánchez, B., Rodríguez, V., Alvarez-santana, R., Leisman, G., ... Arrufat-pié, E. (2019). Autonomic impairment of patients in coma with different Glasgow coma score assessed with heart rate variability. Brain Injury, 33(4), 496-516. https://doi.org/10.1080/02699052.2018.1553312
Estévez-báez, Mario ; Machado, Calixto ; García-sánchez, Benjamín ; Rodríguez, Valia ; Alvarez-santana, Reynaldo ; Leisman, Gerry ; Carrera, José Mario Estévez ; Schiavi, Adam ; Montes-brown, Julio ; Arrufat-pié, Eduardo. / Autonomic impairment of patients in coma with different Glasgow coma score assessed with heart rate variability. In: Brain Injury. 2019 ; Vol. 33, No. 4. pp. 496-516.
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Estévez-báez, M, Machado, C, García-sánchez, B, Rodríguez, V, Alvarez-santana, R, Leisman, G, Carrera, JME, Schiavi, A, Montes-brown, J & Arrufat-pié, E 2019, 'Autonomic impairment of patients in coma with different Glasgow coma score assessed with heart rate variability', Brain Injury, vol. 33, no. 4, pp. 496-516. https://doi.org/10.1080/02699052.2018.1553312

Autonomic impairment of patients in coma with different Glasgow coma score assessed with heart rate variability. / Estévez-báez, Mario; Machado, Calixto; García-sánchez, Benjamín; Rodríguez, Valia; Alvarez-santana, Reynaldo; Leisman, Gerry; Carrera, José Mario Estévez; Schiavi, Adam; Montes-brown, Julio; Arrufat-pié, Eduardo.

In: Brain Injury, Vol. 33, No. 4, 21.03.2019, p. 496-516.

Research output: Contribution to journalArticle

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T1 - Autonomic impairment of patients in coma with different Glasgow coma score assessed with heart rate variability

AU - Estévez-báez, Mario

AU - Machado, Calixto

AU - García-sánchez, Benjamín

AU - Rodríguez, Valia

AU - Alvarez-santana, Reynaldo

AU - Leisman, Gerry

AU - Carrera, José Mario Estévez

AU - Schiavi, Adam

AU - Montes-brown, Julio

AU - Arrufat-pié, Eduardo

N1 - This is an Accepted Manuscript of an article published by Taylor & Francis Group in Brain Injury on 12 Feb 2019, available online at: http://www.tandfonline.com/10.1080/02699052.2018.1553312

PY - 2019/3/21

Y1 - 2019/3/21

N2 - Primary objective: The objective of this study is to assess the functional state of the autonomic nervous system in healthy individuals and in individuals in coma using measures of heart rate variability (HRV) and to evaluate its efficiency in predicting mortality. Design and Methods: Retrospective group comparison study of patients in coma classified into two subgroups, according to their Glasgow coma score, with a healthy control group. HRV indices were calculated from 7 min of artefact-free electrocardiograms using the Hilbert–Huang method in the spectral range 0.02–0.6 Hz. A special procedure was applied to avoid confounding factors. Stepwise multiple regression logistic analysis (SMLRA) and ROC analysis evaluated predictions. Results: Progressive reduction of HRV was confirmed and was associated with deepening of coma and a mortality score model that included three spectral HRV indices of absolute power values of very low, low and very high frequency bands (0.4-0.6 Hz). The SMLRA model showed sensitivity of 95.65%, specificity of 95.83%, positive predictive value of 95.65%, and overall efficiency of 95.74%. Conclusions: HRV is a reliable method to assess the integrity of the neural control of the caudal brainstem centres on the hearts of patients in coma and to predict patient mortality.

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KW - autonomic nervous system

KW - coma

KW - Glasgow coma scale

KW - Heart rate variability

KW - Hilbert–Huang transform

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