ArticlePloS one2019
Combining quick sequential organ failure assessment score with heart rate variability may improve predictive ability for mortality in septic patients at the emergency department.
Article in PloS one, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.
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Who cites it
11 citing papers in PubMed, 2 syntheses or guidelines pooled it, 21 citations in OpenAlex.
- Advances in Patient Monitoring Systems for Prehospital and Resource-Limited Settings.The western journal of emergency medicine · 2026Pooled it
- Machine learning for the prediction of sepsis-related death: a systematic review and meta-analysis.BMC medical informatics and decision making · 2023Pooled it
- Temporal Changes in Nonlinear Heart Rate Variability Following Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation.Acta Cardiologica Sinica · 2026Article
- Improved 28-day mortality prediction by combining Lactate Dehydrogenase-to-Albumin Ratio(LAR) to lactate-enhanced Sequential Organ Failure Assessment (SOFA) score in patients with sepsis: a derivation and validation study.BMC infectious diseases · 2026Article
- A comparison of predictors for mortality and bacteraemia in patients suspected of infection.BMC infectious diseases · 2021Article
- Autonomic Nervous System Dysfunction Is Associated With Re-hospitalization in Pediatric Septic Shock Survivors.Frontiers in pediatrics · 2021Article
- The sensitivity of qSOFA calculated at triage and during emergency department treatment to rapidly identify sepsis patients.Scientific reports · 2020Observational
- Predictors of Appropriate Antibiotic Use in Bacteremia Patients Presenting at the Emergency Department.Antibiotics (Basel, Switzerland) · 2019Article
- 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 · 2019Article
- A Personalized Signature and Chronotherapy-Based Platform for Improving the Efficacy of Sepsis Treatment.Frontiers in physiology · 2019Review
- Exploration of autonomic regulation reflecting on pathophysiological change of sepsis: a prospective observational study.Acute medicine & surgeryArticle
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Authors and funding
7 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAlthough the quick Sequential Organ Failure Assessment (qSOFA) score was recently introduced to identify patients with suspected infection/sepsis, it has limitations as a predictive tool for adverse outcomes. We hypothesized that combining qSOFA score with heart rate variability (HRV) variables improves predictive ability for mortality in septic patients at the emergency department (ED).
methodsThis was a retrospective study using the electronic medical record of a tertiary care hospital in Singapore between September 2014 and February 2017. All patients aged 21 years or older who were suspected with infection/sepsis in the ED and received electrocardiography monitoring with ZOLL X Series Monitor (ZOLL Medical Corporation, Chelmsford, MA) were included. We fitted a logistic regression model to predict the 30-day mortality using one of the HRV variables selected from one of each three domains those previously reported as strong association with mortality (i.e. standard deviation of NN [SDNN], ratio of low frequency to high frequency power [LF/HF], detrended fluctuation analysis α-2 [DFA α-2]) in addition to the qSOFA score. The predictive accuracy was assessed with other scoring systems (i.e. qSOFA alone, National Early Warning Score, and Modified Early Warning Score) using the area under the receiver operating characteristic curve.
resultsA total of 343 septic patients were included. Non-survivors were significantly older (survivors vs. non-survivors, 65.7 vs. 72.9, p <0.01) and had higher qSOFA (0.8 vs. 1.4, p <0.01) as compared to survivors. There were significant differences in HRV variables between survivors and non-survivors including SDNN (23.7s vs. 31.8s, p = 0.02), LF/HF (2.8 vs. 1.5, p = 0.02), DFA α-2 (1.0 vs. 0.7, P < 0.01). Our prediction model using DFA-α-2 had the highest c-statistic of 0.76 (95% CI, 0.70 to 0.82), followed by qSOFA of 0.68 (95% CI, 0.62 to 0.75), National Early Warning Score at 0.67 (95% CI, 0.61 to 0.74), and Modified Early Warning Score at 0.59 (95% CI, 0.53 to 0.67).
conclusionsAdding DFA-α-2 to the qSOFA score may improve the accuracy of predicting in-hospital mortality in septic patients who present to the ED. Further multicenter prospective studies are required to confirm our results.
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