Please use this identifier to cite or link to this item: https://doi.org/10.3390/ijerph16101725
Title: Combining heart rate variability with disease severity score variables for mortality risk stratification in septic patients presenting at the emergency department
Authors: 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. 
Keywords: Emergency department
Heart rate variability
Mortality
Prediction
Sepsis
Issue Date: 2019
Publisher: MDPI AG
Citation: 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. ScholarBank@NUS Repository. https://doi.org/10.3390/ijerph16101725
Rights: Attribution 4.0 International
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. © 2019 by the authors. Licensee MDPI, Basel, Switzerland.
Source Title: International Journal of Environmental Research and Public Health
URI: https://scholarbank.nus.edu.sg/handle/10635/209577
ISSN: 1661-7827
DOI: 10.3390/ijerph16101725
Rights: Attribution 4.0 International
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