Heart Rate Variability and Cerebral Autoregulation in Patients with Traumatic Brain Injury with Paroxysmal Sympathetic Hyperactivity Syndrome.

IF 3.1 3区医学 Q2 CLINICAL NEUROLOGY

Neurocritical Care Pub Date : 2025-06-01 Epub Date: 2024-10-29 DOI:10.1007/s12028-024-02149-1

Małgorzata Burzyńska, Jowita Woźniak, Piotr Urbański, Jarosław Kędziora, Rafał Załuski, Waldemar Goździk, Agnieszka Uryga

{"title":"Heart Rate Variability and Cerebral Autoregulation in Patients with Traumatic Brain Injury with Paroxysmal Sympathetic Hyperactivity Syndrome.","authors":"Małgorzata Burzyńska, Jowita Woźniak, Piotr Urbański, Jarosław Kędziora, Rafał Załuski, Waldemar Goździk, Agnieszka Uryga","doi":"10.1007/s12028-024-02149-1","DOIUrl":null,"url":null,"abstract":"Background: Severe traumatic brain injury (TBI) can lead to transient changes in autonomic nervous system (ANS) functioning and development of paroxysmal sympathetic hyperactivity (PSH) syndrome. Clinical manifestation of ANS disorders may be obscured by therapeutic interventions in TBI. This study aims to analyze ANS metrics and cerebral autoregulation in patients with PSH syndrome to determine their significance in early prognostication.Methods: This single-center retrospective study investigated the relationship between changes in ANS metrics, cerebral autoregulation, and PSH syndrome. Arterial blood pressure and intracranial pressure signals were monitored for 5 days post TBI. ANS metrics included time and frequency domain heart rate variability (HRV) metrics. Cerebral autoregulation was assessed using the pressure reactivity index.Results: Sixty-six patients with severe TBI (median age 33 [interquartile range 26-50] years) were analyzed, and PSH was confirmed in nine cases. Impairment of cerebral autoregulation was observed in 67% of patients with PSH and 72% without the syndrome. Patients with PSH had higher HRV in the low-frequency range (LF; 253 ± 178 vs. 176 ± 227 ms2; p = 0.035) and lower heart rates (HRs; 70 ± 7 vs. 78 ± 19 bpm; p = 0.027) compared to those without PSH. A receiver operating characteristic curve analysis indicated that HR (area under the curve (AUC) = 0.73, p = 0.006) and HRV in the LF (AUC = 0.70, p = 0.009) are moderate predictors of PSH. In the multiple logistic regression model for PSH, diffuse axonal trauma (odds ratio (OR) = 10.82, 95% confidence interval (CI) = 1.70-68.98, p = 0.012) and HR (OR = 0.91, 95% CI 0.84-0.98, p = 0.021) were significant factors.Conclusions: Elevated HRV in the LF and decreased HR may serve as early predictors of PSH syndrome development, particularly in patients with diffuse axonal trauma. Further research is needed to investigate the utility of the cerebral autoregulation-ANS relationship in PSH prognostication.","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"864-877"},"PeriodicalIF":3.1000,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12137448/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurocritical Care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s12028-024-02149-1","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/10/29 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Severe traumatic brain injury (TBI) can lead to transient changes in autonomic nervous system (ANS) functioning and development of paroxysmal sympathetic hyperactivity (PSH) syndrome. Clinical manifestation of ANS disorders may be obscured by therapeutic interventions in TBI. This study aims to analyze ANS metrics and cerebral autoregulation in patients with PSH syndrome to determine their significance in early prognostication.

Methods: This single-center retrospective study investigated the relationship between changes in ANS metrics, cerebral autoregulation, and PSH syndrome. Arterial blood pressure and intracranial pressure signals were monitored for 5 days post TBI. ANS metrics included time and frequency domain heart rate variability (HRV) metrics. Cerebral autoregulation was assessed using the pressure reactivity index.

Results: Sixty-six patients with severe TBI (median age 33 [interquartile range 26-50] years) were analyzed, and PSH was confirmed in nine cases. Impairment of cerebral autoregulation was observed in 67% of patients with PSH and 72% without the syndrome. Patients with PSH had higher HRV in the low-frequency range (LF; 253 ± 178 vs. 176 ± 227 ms²; p = 0.035) and lower heart rates (HRs; 70 ± 7 vs. 78 ± 19 bpm; p = 0.027) compared to those without PSH. A receiver operating characteristic curve analysis indicated that HR (area under the curve (AUC) = 0.73, p = 0.006) and HRV in the LF (AUC = 0.70, p = 0.009) are moderate predictors of PSH. In the multiple logistic regression model for PSH, diffuse axonal trauma (odds ratio (OR) = 10.82, 95% confidence interval (CI) = 1.70-68.98, p = 0.012) and HR (OR = 0.91, 95% CI 0.84-0.98, p = 0.021) were significant factors.

Conclusions: Elevated HRV in the LF and decreased HR may serve as early predictors of PSH syndrome development, particularly in patients with diffuse axonal trauma. Further research is needed to investigate the utility of the cerebral autoregulation-ANS relationship in PSH prognostication.

查看原文本刊更多论文

伴有阵发性交感神经功能亢进综合征的脑外伤患者的心率变异性和大脑自主调节功能。

背景：严重创伤性脑损伤（TBI）可导致自律神经系统（ANS）功能发生短暂变化，并发展为阵发性交感神经活动亢进综合征（PSH）。TBI治疗干预可能会掩盖ANS紊乱的临床表现。本研究旨在分析 PSH 综合征患者的自律神经系统指标和大脑自动调节功能，以确定其在早期预后中的意义：这项单中心回顾性研究调查了自律神经系统指标变化、脑自动调节和 PSH 综合征之间的关系。对创伤后 5 天的动脉血压和颅内压信号进行了监测。自律神经系统指标包括时域和频域心率变异性（HRV）指标。使用压力反应指数评估脑的自动调节功能：结果：分析了 66 名严重创伤性脑损伤患者（中位年龄 33 [四分位数范围 26-50] 岁），其中 9 例证实了 PSH。在 67% 的 PSH 患者和 72% 的非 PSH 患者中观察到了大脑自动调节功能受损。与无 PSH 的患者相比，PSH 患者的低频范围 HRV（LF；253 ± 178 vs. 176 ± 227 ms2；p = 0.035）较高，心率（HRs；70 ± 7 vs. 78 ± 19 bpm；p = 0.027）较低。接收器操作特征曲线分析表明，心率（曲线下面积 (AUC) = 0.73，p = 0.006）和低频心率变异（AUC = 0.70，p = 0.009）是 PSH 的中度预测因子。在 PSH 的多重逻辑回归模型中，弥漫性轴索创伤（几率比（OR）= 10.82，95% 置信区间（CI）= 1.70-68.98，p = 0.012）和心率变异（OR = 0.91，95% CI 0.84-0.98，p = 0.021）是重要的预测因素：结论：低频心率变异升高和心率减低可作为 PSH 综合征发展的早期预测因素，尤其是在弥漫性轴索创伤患者中。需要进一步研究大脑自动调节-ANS关系在PSH预后中的作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Neurocritical Care 医学-临床神经学

CiteScore

7.40

自引率

8.60%

发文量

221

审稿时长

4-8 weeks

期刊介绍： Neurocritical Care is a peer reviewed scientific publication whose major goal is to disseminate new knowledge on all aspects of acute neurological care. It is directed towards neurosurgeons, neuro-intensivists, neurologists, anesthesiologists, emergency physicians, and critical care nurses treating patients with urgent neurologic disorders. These are conditions that may potentially evolve rapidly and could need immediate medical or surgical intervention. Neurocritical Care provides a comprehensive overview of current developments in intensive care neurology, neurosurgery and neuroanesthesia and includes information about new therapeutic avenues and technological innovations. Neurocritical Care is the official journal of the Neurocritical Care Society.