Citation

Florez-Perdomo WA, Garcia-Ballestas E, Rafael Moscote-Salazar L, Konar SK, Raj S, Chouksey P, Shrivastava A, Mishra R, Agrawal A. World Neurosurg. 2021; ePub(ePub): ePub.

Copyright

(Copyright © 2021, Elsevier Publishing)

DOI

10.1016/j.wneu.2020.12.132

PMID

unavailable

Abstract

OBJECTIVE: Systematically review the medical literature to determine the utility of heart rate variability in predicting mortality for moderate to severe traumatic brain injury METHODS: We followed the recommendations of the meta-analysis and systematic reviews of the PRISMA declaration for the presentation of the systematic reviews and meta-analysis as well as the Cochrane manual of systematic reviews and meta-analysis. SEARCH: A search for randomized controlled trials (RCTs), not RCTs and prospective & retrospective cohort studies was carried out through PUBMED (until 7(th) March 2020); SCOPUS (until 7(th) March- 2020); Central Cochrane Registry of Controlled Trials (The Cochrane Library) (until 7(th) March 2020); MEDLINE (Ovid) until February 2020; EMBASE (Ovid); PubMed [http://www.ncbi.nlm.nih.gov/sites/entrez] (until February 2020).In addition, reference list of included studies were searched to identify potentially eligible studies.

RESULTS: A total of five (n=5) articles met the inclusion criteria. A total of 542 patients were included in the analysis. The heart rate variability as LF/HF ratio (Low frequency/ High Frequency) (Area under ROC) predicting the mortality was found to be statistically significant (ROC AUC area:0.810, p<0.001) with high heterogenicity (I(2)=61.98%, P=0.032). The met-analysis of LF/HF Ratio (Low frequency/ High Frequency) (cut-off >1.2) showed an odds ratio of 16.17(CI 95%: 4.373 to 59.861) (p=<0.001) in predicting the mortality. The high-frequency peak, predicting mortality showed a ROC area of 0.986 (p=<0.001) with a low level of heterogeneity. The met-analysis results of High Frequency Peak (HF) (cut-off >107.2 beats per minute) reflected the odds ratio of 19.09(CI 95% 6.348 to 57.423) (p=<0.001) in predicting the mortality. The total power variable showed a ROC area of 0.93 (p<0.001) in predicting mortality after TBI with a high level of heterogeneity (I2=83.16 %, P=0.002). The pooled analysis of total power (TP) (cut-off >504.7 m2) showed an odds ratio of 22.59 (CI 95% 11.380 to 44.877) (p=<0.001) in predicting mortality. Funnel plot analysis to assess the presence of publication bias for the variable Total Power (TP) showed a high level of heterogeneity and asymmetry between the included studies.

CONCLUSION: This meta-analysis predicts high mortality based on the odds ratio for variables like LF/HF ratio, high-frequency peak and total power. But the strength of the statistical analysis gets underrated due to the high level of heterogeneity in the included studies. Further quality research is needed to generate high-quality recommendations regarding HRV as a predictor of mortality after TBI.

Language: en

Keywords

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