@article{ref1,
title="Heart rate variability as a predictor of mortality in traumatic brain injury: a systematic review and meta-analysis",
journal="World neurosurgery",
year="2021",
author="Agrawal, Amit and Mishra, Rakesh and Shrivastava, Adesh and Chouksey, Pradeep and Raj, Sumit and Rafael Moscote-Salazar, Luis and Garcia-Ballestas, Ezequiel and Florez-Perdomo, William Andres and Konar, Subhas K.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
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. <br><br>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. <br><br>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.<p /> <p>Language: en</p>",
language="en",
issn="1878-8750",
doi="10.1016/j.wneu.2020.12.132",
url="http://dx.doi.org/10.1016/j.wneu.2020.12.132"
}