ArticleIntensive care medicine experimental2020
Autonomic nervous system activity and the risk of nosocomial infection in critically ill patients with brain injury.
Article in Intensive care medicine experimental, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.
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Who cites it
7 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Heart rate variability as a predictor of stroke course, functional outcome, and medical complications: A systematic review.Frontiers in physiology · 2023Pooled it
- Epidemiology and Outcomes of Battlefield-Related Penetrating and Closed Traumatic Brain Injuries Compared to Non-Head Injuries: A Retrospective Cohort Study.Military medicine · 2026Article
- Gene expression changes in lymphocytes and monocytes from patients with traumatic brain injury.Scientific reports · 2026Article
- Hospital-acquired infections as a risk factor for post-traumatic epilepsy: A registry-based cohort study.Epilepsia open · 2024Article
- Bi-directional neuro-immune dysfunction after chronic experimental brain injury.Journal of neuroinflammation · 2024Article
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Authors and funding
9 authors.
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Abstract
purposeNosocomial infection contributes to adverse outcome after brain injury. This study investigates whether autonomic nervous system activity is associated with a decreased host immune response in patients following stroke or traumatic brain injury (TBI).
methodsA prospective study was performed in adult patients with TBI or stroke who were admitted to the Intensive Care Unit of our tertiary university hospital between 2013 and 2016. Heart rate variability (HRV) was recorded daily and assessed for autonomic nervous system activity. Outcomes were nosocomial infections and immunosuppression, which was assessed ex vivo using whole blood stimulations with plasma of patients with infections, matched non-infected patients and healthy controls.
resultsOut of 64 brain injured patients, 23 (36%) developed an infection during their hospital stay. The ability of brain injured patients to generate a host response to the bacterial endotoxin lipopolysaccharides (LPS) was diminished compared to healthy controls (p < 0.001). Patients who developed an infection yielded significantly lower TNF-α values (86 vs 192 pg/mL, p = 0.030) and a trend towards higher IL-10 values (122 vs 84 pg/mL, p = 0.071) following ex vivo whole blood stimulations when compared to patients not developing an infection. This decreased host immune response was associated with altered admission HRV values. Brain injured patients who developed an infection showed increased normalized high-frequency power compared to patients not developing an infection (0.54 vs 0.36, p = 0.033), whereas normalized low-frequency power was lower in infected patients (0.46 vs 0.64, p = 0.033).
conclusionBrain injured patients developing a nosocomial infection show parasympathetic predominance in the acute phase following brain injury, reflected by alterations in HRV, which parallels a decreased ability to generate an immune response to stimulation with LPS.
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