Specific Components Of The Inflammatory Reflex: Heart Rate Variability (HRV) And Il-6 Predict Septic Shock In Critical Ill Patients

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Resumen

Background: High rates of septic shock lead to human losts and economic costs. Unfortunately, we lack a reliable predictor of septic shock. Identifying it is a cornerstone to decrease mortality. We aimed to evaluate the reliability of the so-called inflammatory reflex (focusing on inflammatory response and autonomic dysfunction) as a predictor of septic shock.

Materials and Methods: We conducted a prospective study in adults admitted to the ICU of Hospital San Ignacio, Bogotá, Colombia, who met criteria for sepsis. A single 15 minute ECG was recorded using a Powerlab® and measures of HRV were calculated. Levels of Epinephrine, Norepinephrine, TNF and Interleukins were obtained from blood samples. Blood chemistry and HRV were correlated with outcome (shock vs. no shock) after 24 hours.

Results: Regarding HRV, we observed an increase in RMSSD (p<0.01)and the HF component (p<0.01)and lower levels of LF (p<0.05) and LF/HF ratio (p<0.01) in the baseline measurement of patients who developed shock. Moreover, patients exhibited lower levels of IL-6 (p<0.05) and norepinephrine (p<0.01) in the baseline measurements of patients who developed shock. We did not observed significant differences across other variables.

Conclusions: Our results indicate that patients who progress to shock have an increased inflammatory reflex (autonomic response with a predominantly vagal activity and a decreased sympathetic-vagal ratio with a decreased inflammatory response). We conclude that specific components of the inflammatory reflex, namely HRV and IL-6, are reliable predictors of septic shock in critical patients.
Idioma originalInglés
DOI
EstadoPublicada - 2016

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