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Volume 16
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Article

Combining Heart Rate Variability with Disease Severity Score Variables for Mortality Risk Stratification in Septic Patients Presenting at the Emergency Department

by
Jeremy Zhenwen Pong
1,
Stephanie Fook-Chong
2,
Zhi Xiong Koh
3,
Mas’uud Ibnu Samsudin
4,
Takashi Tagami
5,
Calvin J. Chiew
6,
Ting Hway Wong
7,
Andrew Fu Wah Ho
3,
Marcus Eng Hock Ong
1,3 and
Nan Liu
1,8,*
1
Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore
2
Health Services Research Unit, Singapore General Hospital, Singapore 169608, Singapore
3
Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore
4
General Medicine, Ministry of Health Holdings, Singapore 099253, Singapore
5
Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo 206-8512, Japan
6
Preventive Medicine Residency Program, National University Health System, Singapore 119228, Singapore
7
Department of General Surgery, Singapore General Hospital, Singapore 169608, Singapore
8
Health Services Research Centre, Singapore Health Services, Singapore 169856, Singapore
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(10), 1725; https://doi.org/10.3390/ijerph16101725
Submission received: 16 April 2019 / Revised: 13 May 2019 / Accepted: 14 May 2019 / Published: 16 May 2019
(This article belongs to the Section Health Care Sciences & Services)
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Abstract

The emergency department (ED) serves as the first point of hospital contact for many septic patients, where risk-stratification would be invaluable. We devised a combination model incorporating demographic, clinical, and heart rate variability (HRV) parameters, alongside individual variables of the Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation II (APACHE II), and Mortality in Emergency Department Sepsis (MEDS) scores for mortality risk-stratification. ED patients fulfilling systemic inflammatory response syndrome criteria were recruited. National Early Warning Score (NEWS), Modified Early Warning Score (MEWS), quick SOFA (qSOFA), SOFA, APACHE II, and MEDS scores were calculated. For the prediction of 30-day in-hospital mortality, combination model performed with an area under the receiver operating characteristic curve of 0.91 (95% confidence interval (CI): 0.88–0.95), outperforming NEWS (0.70, 95% CI: 0.63–0.77), MEWS (0.61, 95% CI 0.53–0.69), qSOFA (0.70, 95% CI 0.63–0.77), SOFA (0.74, 95% CI: 0.67–0.80), APACHE II (0.76, 95% CI: 0.69–0.82), and MEDS scores (0.86, 95% CI: 0.81–0.90). The combination model had an optimal sensitivity and specificity of 91.4% (95% CI: 81.6–96.5%) and 77.9% (95% CI: 72.6–82.4%), respectively. A combination model incorporating clinical, HRV, and disease severity score variables showed superior predictive ability for the mortality risk-stratification of septic patients presenting at the ED.
Keywords: heart rate variability; sepsis; mortality; prediction; emergency department heart rate variability; sepsis; mortality; prediction; emergency department

Share and Cite

MDPI and ACS Style

Pong, J.Z.; Fook-Chong, S.; Koh, Z.X.; Samsudin, M.I.; Tagami, T.; Chiew, C.J.; Wong, T.H.; Ho, A.F.W.; Ong, M.E.H.; Liu, N. Combining Heart Rate Variability with Disease Severity Score Variables for Mortality Risk Stratification in Septic Patients Presenting at the Emergency Department. Int. J. Environ. Res. Public Health 2019, 16, 1725. https://doi.org/10.3390/ijerph16101725

AMA Style

Pong JZ, Fook-Chong S, Koh ZX, Samsudin MI, Tagami T, Chiew CJ, Wong TH, Ho AFW, Ong MEH, Liu N. Combining Heart Rate Variability with Disease Severity Score Variables for Mortality Risk Stratification in Septic Patients Presenting at the Emergency Department. International Journal of Environmental Research and Public Health. 2019; 16(10):1725. https://doi.org/10.3390/ijerph16101725

Chicago/Turabian Style

Pong, Jeremy Zhenwen, Stephanie Fook-Chong, Zhi Xiong Koh, Mas’uud Ibnu Samsudin, Takashi Tagami, Calvin J. Chiew, Ting Hway Wong, Andrew Fu Wah Ho, Marcus Eng Hock Ong, and Nan Liu. 2019. "Combining Heart Rate Variability with Disease Severity Score Variables for Mortality Risk Stratification in Septic Patients Presenting at the Emergency Department" International Journal of Environmental Research and Public Health 16, no. 10: 1725. https://doi.org/10.3390/ijerph16101725

APA Style

Pong, J. Z., Fook-Chong, S., Koh, Z. X., Samsudin, M. I., Tagami, T., Chiew, C. J., Wong, T. H., Ho, A. F. W., Ong, M. E. H., & Liu, N. (2019). Combining Heart Rate Variability with Disease Severity Score Variables for Mortality Risk Stratification in Septic Patients Presenting at the Emergency Department. International Journal of Environmental Research and Public Health, 16(10), 1725. https://doi.org/10.3390/ijerph16101725

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