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Heart rate before ICU discharge: a simple and readily available predictor of short- and long-term mortality from critical illness

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Clinical Research in Cardiology Aims and scope Submit manuscript

Abstract

Purpose

A heart rate >90 bpm serves as one of four characteristics defining the systemic inflammatory response syndrome and is used in scoring systems to predict in-hospital mortality of intensive care unit (ICU) patients. Despite its central role in critical illness, specific data regarding the relationship between heart rate and outcome are rare.

Methods

In this post hoc analysis of a prospectively collected database, we analyzed the value of heart rate averaged from four predefined time points during the last 24 h before ICU discharge as a predictor of post-ICU in-hospital and post-hospital mortality in medical ICU patients. Furthermore, the relationship between heart rate and inflammation, as well as the influence of rate control medications on the association between heart rate and outcome were identified.

Results

Among the 702 ICU patients discharged from the ICU, 7.1 % died before hospital discharge. At 4 years of follow-up, post-hospital mortality was 14.4 %. Multivariate Cox proportional hazards models revealed heart rate before ICU discharge (HR 5.95; 95 % CI 1.24–28.63; p = 0.03) as an independent predictor of post-ICU in-hospital mortality. Both heart rate (HR 2.56; 95 % CI, 1.05−6.34; p = 0.04) and the C-reactive protein serum concentration before ICU discharge (HR, 1.26; 95 % CI, 1.09–1.46; p = 0.002) were independently associated with post-hospital mortality. Heart rate control therapy reduced the risk of post-ICU in-hospital (HR 0.38; 95 % CI, 0.18–0.81; p = 0.01) and post-hospital (HR, 0.47; 95 % CI, 0.22–1.00; p = 0.05) mortality.

Conclusion

Heart rate evaluated 24 h before ICU discharge was independently associated with post-ICU in-hospital and post-hospital mortality. Pharmacological interventions to control heart rate may beneficially influence post-ICU mortality.

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Acknowledgments

Raffaella Gothe; Dip-Stat.: Center of Statistical Consulting. UMIT; Austria.

Conflict of interest

No author has a conflict of interest in regards of drugs or techniques discussed in this manuscript.

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Authors and Affiliations

  1. Department of Internal Medicine, Academic Teaching Hospital Hall in Triol, Milserstrasse 10, 6060, Hall in Tirol, Austria

    Wilhelm Grander, Kathrin Müllauer, Bernhard Koller & Herbert Tilg

  2. Department of Anesthesiology and Intensive Care Medicine, Paracelsus Private Medical University, Salzburg, Austria

    Martin Dünser

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  1. Wilhelm Grander
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  2. Kathrin Müllauer
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  3. Bernhard Koller
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  4. Herbert Tilg
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  5. Martin Dünser
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Correspondence to Wilhelm Grander.

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Grander, W., Müllauer, K., Koller, B. et al. Heart rate before ICU discharge: a simple and readily available predictor of short- and long-term mortality from critical illness. Clin Res Cardiol 102, 599–606 (2013). https://doi.org/10.1007/s00392-013-0571-4

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  • DOI: https://doi.org/10.1007/s00392-013-0571-4

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