Admission Heart Rate Variability is Associated with Fever Development in Patients with Intracerebral Hemorrhage

Dionne E. Swor, Leena F. Thomas, Matthew Brandon Maas, Daniela Grimaldi, Edward Michael Manno, Farzaneh A Sorond, Ayush Batra, Minjee Kim, Shyam Prabhakaran, Andrew M Naidech, Eric Michael Liotta*

*Corresponding author for this work

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Fever is associated with worse outcome after intracerebral hemorrhage (ICH). Autonomic dysfunction, commonly seen after brain injury, results in reduced heart rate variability (HRV). We sought to investigate whether HRV was associated with the development of fever in patients with ICH. Methods: We prospectively enrolled consecutive patients with spontaneous ICH in a single-center observational study. We included patients who presented directly to our emergency department after symptom onset, had a 10-second electrocardiogram (EKG) performed within 24 h of admission, and were in sinus rhythm. Patient temperature was recorded every 1–4 h. We defined being febrile as having a temperature of ≥ 38 °C within the first 14 days, and fever burden as the number of febrile days. HRV was defined by the standard deviation of the R-R interval (SDNN) measured on the admission EKG. Univariate associations were determined by Fisher’s exact, Mann–Whitney U, or Spearman’s rho correlation tests. Variables associated with fever at p ≤ 0.2 were entered in a logistic regression model of being febrile within 14 days. Results: There were 248 patients (median age 63 [54–74] years, 125 [50.4%] female, median ICH Score 1 [0–2]) who met the inclusion criteria. Febrile patients had lower HRV (median SDNN: 1.72 [1.08–3.60] vs. 2.55 [1.58–5.72] msec, p = 0.001). Lower HRV was associated with more febrile days (R = − 0.22, p < 0.001). After adjustment, lower HRV was independently associated with greater odds of fever occurrence (OR 0.92 [95% CI 0.87–0.97] with each msec increase in SDNN, p = 0.002). Conclusions: HRV measured on 10-second EKGs is a potential early marker of parasympathetic nervous system dysfunction and is associated with subsequent fever occurrence after ICH. Detecting early parasympathetic dysfunction may afford opportunities to improve ICH outcome by targeting therapies at fever prevention.

Original languageEnglish (US)
Pages (from-to)244-250
Number of pages7
JournalNeurocritical Care
Volume30
Issue number2
DOIs
StatePublished - Apr 15 2019

Fingerprint

Cerebral Hemorrhage
Fever
Heart Rate
Electrocardiography
Logistic Models
Parasympathetic Nervous System
Induced Hyperthermia
Temperature
Brain Injuries
Observational Studies
Hospital Emergency Service

Keywords

  • Autonomic dysfunction
  • Fever
  • Heart rate variability
  • Intracerebral hemorrhage

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Cite this

@article{a7b15487d74248efbbc2cc3cedc539f9,
title = "Admission Heart Rate Variability is Associated with Fever Development in Patients with Intracerebral Hemorrhage",
abstract = "Background: Fever is associated with worse outcome after intracerebral hemorrhage (ICH). Autonomic dysfunction, commonly seen after brain injury, results in reduced heart rate variability (HRV). We sought to investigate whether HRV was associated with the development of fever in patients with ICH. Methods: We prospectively enrolled consecutive patients with spontaneous ICH in a single-center observational study. We included patients who presented directly to our emergency department after symptom onset, had a 10-second electrocardiogram (EKG) performed within 24 h of admission, and were in sinus rhythm. Patient temperature was recorded every 1–4 h. We defined being febrile as having a temperature of ≥ 38 °C within the first 14 days, and fever burden as the number of febrile days. HRV was defined by the standard deviation of the R-R interval (SDNN) measured on the admission EKG. Univariate associations were determined by Fisher’s exact, Mann–Whitney U, or Spearman’s rho correlation tests. Variables associated with fever at p ≤ 0.2 were entered in a logistic regression model of being febrile within 14 days. Results: There were 248 patients (median age 63 [54–74] years, 125 [50.4{\%}] female, median ICH Score 1 [0–2]) who met the inclusion criteria. Febrile patients had lower HRV (median SDNN: 1.72 [1.08–3.60] vs. 2.55 [1.58–5.72] msec, p = 0.001). Lower HRV was associated with more febrile days (R = − 0.22, p < 0.001). After adjustment, lower HRV was independently associated with greater odds of fever occurrence (OR 0.92 [95{\%} CI 0.87–0.97] with each msec increase in SDNN, p = 0.002). Conclusions: HRV measured on 10-second EKGs is a potential early marker of parasympathetic nervous system dysfunction and is associated with subsequent fever occurrence after ICH. Detecting early parasympathetic dysfunction may afford opportunities to improve ICH outcome by targeting therapies at fever prevention.",
keywords = "Autonomic dysfunction, Fever, Heart rate variability, Intracerebral hemorrhage",
author = "Swor, {Dionne E.} and Thomas, {Leena F.} and Maas, {Matthew Brandon} and Daniela Grimaldi and Manno, {Edward Michael} and Sorond, {Farzaneh A} and Ayush Batra and Minjee Kim and Shyam Prabhakaran and Naidech, {Andrew M} and Liotta, {Eric Michael}",
year = "2019",
month = "4",
day = "15",
doi = "10.1007/s12028-019-00684-w",
language = "English (US)",
volume = "30",
pages = "244--250",
journal = "Neurocritical Care",
issn = "1541-6933",
publisher = "Humana Press",
number = "2",

}

TY - JOUR

T1 - Admission Heart Rate Variability is Associated with Fever Development in Patients with Intracerebral Hemorrhage

AU - Swor, Dionne E.

AU - Thomas, Leena F.

AU - Maas, Matthew Brandon

AU - Grimaldi, Daniela

AU - Manno, Edward Michael

AU - Sorond, Farzaneh A

AU - Batra, Ayush

AU - Kim, Minjee

AU - Prabhakaran, Shyam

AU - Naidech, Andrew M

AU - Liotta, Eric Michael

PY - 2019/4/15

Y1 - 2019/4/15

N2 - Background: Fever is associated with worse outcome after intracerebral hemorrhage (ICH). Autonomic dysfunction, commonly seen after brain injury, results in reduced heart rate variability (HRV). We sought to investigate whether HRV was associated with the development of fever in patients with ICH. Methods: We prospectively enrolled consecutive patients with spontaneous ICH in a single-center observational study. We included patients who presented directly to our emergency department after symptom onset, had a 10-second electrocardiogram (EKG) performed within 24 h of admission, and were in sinus rhythm. Patient temperature was recorded every 1–4 h. We defined being febrile as having a temperature of ≥ 38 °C within the first 14 days, and fever burden as the number of febrile days. HRV was defined by the standard deviation of the R-R interval (SDNN) measured on the admission EKG. Univariate associations were determined by Fisher’s exact, Mann–Whitney U, or Spearman’s rho correlation tests. Variables associated with fever at p ≤ 0.2 were entered in a logistic regression model of being febrile within 14 days. Results: There were 248 patients (median age 63 [54–74] years, 125 [50.4%] female, median ICH Score 1 [0–2]) who met the inclusion criteria. Febrile patients had lower HRV (median SDNN: 1.72 [1.08–3.60] vs. 2.55 [1.58–5.72] msec, p = 0.001). Lower HRV was associated with more febrile days (R = − 0.22, p < 0.001). After adjustment, lower HRV was independently associated with greater odds of fever occurrence (OR 0.92 [95% CI 0.87–0.97] with each msec increase in SDNN, p = 0.002). Conclusions: HRV measured on 10-second EKGs is a potential early marker of parasympathetic nervous system dysfunction and is associated with subsequent fever occurrence after ICH. Detecting early parasympathetic dysfunction may afford opportunities to improve ICH outcome by targeting therapies at fever prevention.

AB - Background: Fever is associated with worse outcome after intracerebral hemorrhage (ICH). Autonomic dysfunction, commonly seen after brain injury, results in reduced heart rate variability (HRV). We sought to investigate whether HRV was associated with the development of fever in patients with ICH. Methods: We prospectively enrolled consecutive patients with spontaneous ICH in a single-center observational study. We included patients who presented directly to our emergency department after symptom onset, had a 10-second electrocardiogram (EKG) performed within 24 h of admission, and were in sinus rhythm. Patient temperature was recorded every 1–4 h. We defined being febrile as having a temperature of ≥ 38 °C within the first 14 days, and fever burden as the number of febrile days. HRV was defined by the standard deviation of the R-R interval (SDNN) measured on the admission EKG. Univariate associations were determined by Fisher’s exact, Mann–Whitney U, or Spearman’s rho correlation tests. Variables associated with fever at p ≤ 0.2 were entered in a logistic regression model of being febrile within 14 days. Results: There were 248 patients (median age 63 [54–74] years, 125 [50.4%] female, median ICH Score 1 [0–2]) who met the inclusion criteria. Febrile patients had lower HRV (median SDNN: 1.72 [1.08–3.60] vs. 2.55 [1.58–5.72] msec, p = 0.001). Lower HRV was associated with more febrile days (R = − 0.22, p < 0.001). After adjustment, lower HRV was independently associated with greater odds of fever occurrence (OR 0.92 [95% CI 0.87–0.97] with each msec increase in SDNN, p = 0.002). Conclusions: HRV measured on 10-second EKGs is a potential early marker of parasympathetic nervous system dysfunction and is associated with subsequent fever occurrence after ICH. Detecting early parasympathetic dysfunction may afford opportunities to improve ICH outcome by targeting therapies at fever prevention.

KW - Autonomic dysfunction

KW - Fever

KW - Heart rate variability

KW - Intracerebral hemorrhage

UR - http://www.scopus.com/inward/record.url?scp=85061515194&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85061515194&partnerID=8YFLogxK

U2 - 10.1007/s12028-019-00684-w

DO - 10.1007/s12028-019-00684-w

M3 - Article

C2 - 30756320

AN - SCOPUS:85061515194

VL - 30

SP - 244

EP - 250

JO - Neurocritical Care

JF - Neurocritical Care

SN - 1541-6933

IS - 2

ER -