Relationship between minimum heart rate and mortality in ICU patients with traumatic brain injury (TBI): a retrospective analysis based on the MIMIC-IV database

IF 1.2 Q4 SURGERY

Surgery in practice and science Pub Date : 2025-12-01 Epub Date: 2025-10-09 DOI:10.1016/j.sipas.2025.100312

Xin Li, Meng Han, Xiaoliang Wang, Wenjuan Lang, Kai Shi

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Abstract

Background

The association between minimum heart rate (MinHR) within 24 h of ICU admission and 1-month mortality in traumatic brain injury (TBI) patients remains unclear.

Methods

This retrospective cohort study analyzed 2267 TBI patients from the MIMIC-IV v3.1 database. Multivariable Cox regression, restricted cubic spline (RCS) analysis, and subgroup analyses evaluated relationships between 24-hour MinHR and mortality.

Results

The cohort (median age 67 [IQR 51–80] years; 62.6% female) had a median MinHR of 59 [52–68] bpm, with 248 deaths (10.94%). RCS analysis revealed a U-shaped association (P for nonlinear =0.001) with 59 bpm as the inflection point. MinHR ≥59 bpm independently predicted higher mortality after full adjustment (HR=1.84, 95%CI:1.31–2.60; P < 0.001). This association was pronounced in non-hypertensive patients (HR=1.50, 95%CI:1.08–2.08; P = 0.015).

Conclusions

A U-shaped association exists between 24-hour MinHR and 1-month mortality in TBI patients, with 59 bpm as the critical threshold. MinHR ≥59 bpm independently predicts increased mortality. These findings support using 59 bpm as an alert threshold for early intervention.

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颅脑损伤（TBI） ICU患者最低心率与死亡率的关系：基于MIMIC-IV数据库的回顾性分析

背景：外伤性脑损伤（TBI）患者入院24小时内最低心率（MinHR）与1个月死亡率之间的关系尚不清楚。方法本回顾性队列研究分析了来自MIMIC-IV v3.1数据库的2267例TBI患者。多变量Cox回归、限制性三次样条（RCS）分析和亚组分析评估了24小时MinHR与死亡率之间的关系。结果该队列（中位年龄67 [IQR 51-80]岁，女性占62.6%）中位MinHR为59 [52-68]bpm，死亡248例（10.94%）。RCS分析显示，以59 bpm为拐点呈u形关联（非线性P =0.001）。MinHR≥59 bpm独立预测完全调整后较高的死亡率（HR=1.84, 95%CI: 1.31-2.60; P < 0.001）。这种关联在非高血压患者中更为明显（HR=1.50, 95%CI: 1.08-2.08; P = 0.015）。结论TBI患者24小时MinHR与1个月死亡率呈u型相关，以59 bpm为临界阈值。MinHR≥59 bpm独立预测死亡率增加。这些发现支持使用59 bpm作为早期干预的警报阈值。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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