Heart Rate Variability as a Predictor of Mortality in Traumatic Brain Injury: A Systematic Review and Meta-Analysis

William Andres Florez-Perdomo; Ezequiel García-Ballestas; Luis Rafael Moscote-Salazar; Subhas K Konar; Sumit Raj; Pradeep Chouksey; Adesh Shrivastava; Rakesh Mishra; Amit Agrawal

doi:10.1016/j.wneu.2020.12.132

Heart Rate Variability as a Predictor of Mortality in Traumatic Brain Injury: A Systematic Review and Meta-Analysis

World Neurosurg. 2021 Apr:148:80-89. doi: 10.1016/j.wneu.2020.12.132. Epub 2021 Jan 4.

Authors

William Andres Florez-Perdomo¹, Ezequiel García-Ballestas², Luis Rafael Moscote-Salazar³, Subhas K Konar⁴, Sumit Raj⁵, Pradeep Chouksey⁵, Adesh Shrivastava⁵, Rakesh Mishra⁵, Amit Agrawal⁶

Affiliations

¹ Medicina General-Universidad Surcolombiana, Medico Investigador Concejo Latinoamericano de Neurointensivismo-CLaNi, Clinica Sahagún IPS SA, Córdoba, Colombia.
² Center for Biomedical Research (CIB), Faculty of Medicine, University of Cartagena, Cartagena, Colombia.
³ Department of Neurosurgery, University of Cartagena, Cartagena de Indias, Colombia.
⁴ Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India.
⁵ Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, India.
⁶ Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, India. Electronic address: dramitagrawal@gmail.com.

PMID: 33412317
DOI: 10.1016/j.wneu.2020.12.132

Abstract

Objective: To systematically review the medical literature to determine the utility of heart rate variability in predicting mortality for moderate to severe traumatic brain injury.

Methods: A search for randomized controlled trials, nonrandomized trials, and prospective and retrospective cohort studies was carried out using PubMed, SCOPUS, Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE. Reference lists of included studies were also searched to identify potentially eligible studies.

Results: Five articles comprising 542 patients met inclusion criteria. Heart rate variability as low-frequency/high-frequency ratio (area under the curve [AUC] receiver operating characteristic [ROC]) for predicting mortality was found to be statistically significant (AUC ROC 0.810, P < 0.001) with high heterogeneity (I² = 61.98%, P = 0.032). Meta-analysis of low-frequency/high-frequency ratio, High frequency peak, and total power were statistically significant for predicting mortality. Odd's ratio for predicting mortality for LF/HF ratio, HF peak, and TP were 16.17, 19.09, 22.59 respectively. High-frequency peak in predicting mortality showed an AUC ROC of 0.986 (P ≤ 0.001) with a low level of heterogeneity. Total power (TP) showed an AUC ROC of 0.93 (P < 0.001) in predicting mortality with a high level of heterogeneity (I² = 83.16%, P = 0.002). Funnel plot analysis to assess the presence of publication bias for TP showed a high level of heterogeneity and asymmetry among studies.

Conclusions: This meta-analysis predicted high mortality based on odds ratio for variables low-frequency/high-frequency ratio, high-frequency peak, and TP. However, the statistical analysis was weakened owing to the high level of heterogeneity in the included studies. Further research is needed to generate high-quality recommendations regarding heart rate variability as a predictor of mortality after traumatic brain injury.

Keywords: Heart rate variable; High-frequency peak; LF/HF ratio; Total power.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Area Under Curve
Autonomic Nervous System / physiopathology*
Brain Injuries, Traumatic / mortality*
Brain Injuries, Traumatic / physiopathology
Heart Rate / physiology*
Humans
Odds Ratio
Prognosis
ROC Curve