Purpose

The autonomic nervous system interacts with the immune system via the inflammatory response. Heart rate variability (HRV), a marker of autonomic activity, is associated with inflammation, and nosocomial infections/sepsis, and has clinical implications for the monitoring of at-risk patients. Due to the vagal tone's influence on anti-inflammatory immune response, this association may predominately be reflected by vagally-mediated HRV indices. However, HRV's predictive significance on inflammation/infection remains unclear.

Methods

843 studies examining the associations/prognostic value of HRV indices on inflammation, and nosocomial infection/sepsis were screened in this systematic review. According to inclusion and exclusion criteria, 68 associative studies and 14 prediction studies were included.

Results

HRV and pro-inflammatory state were consistently associated in healthy subjects and patient groups. Pro-inflammatory state was related to reduced total power HRV including vagally- and non-vagally-mediated HRV indices. Similar, compared to controls, HRV reductions were observed during nosocomial infections/sepsis.

Only limited evidence supports the predictive value of HRV in the development of nosocomial infections/sepsis. Reduced very low frequency power HRV showed the highest predictive value in adults, even with different clinical conditions. In neonates, an increased heart rate characteristic score, combining reduced total power HRV, decreased complexity, and vagally-dominated asymmetry, predicted sepsis.

Conclusions

Pro-inflammatory state is related to an overall reduction in HRV rather than a singular reduction in vagally-mediated HRV indices, reflecting the complex autonomic-regulatory changes occurring during inflammation.

The potential benefit of using continuous HRV monitoring for detecting nosocomial infection-related states, and the implications for clinical outcome, need further clarification.

中文翻译：

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心率变异性作为炎症、医院感染和脓毒症的标志物和预测因子——系统评价

目的

自主神经系统通过炎症反应与免疫系统相互作用。心率变异性 (HRV) 是自主神经活动的标志，与炎症和医院感染/败血症相关，对于监测高危患者具有临床意义。由于迷走神经张力对抗炎免疫反应的影响，这种关联可能主要通过迷走神经介导的 HRV 指数来反映。然而，HRV 对炎症/感染的预测意义仍不清楚。

方法

本系统评价筛选了 843 项研究，检查 HRV 指数与炎症和医院感染/败血症的关联/预后价值。根据纳入和排除标准，纳入了68项关联研究和14项预测研究。

结果

HRV 和促炎症状态在健康受试者和患者组中始终相关。促炎状态与总功率 HRV 降低有关，包括迷走神经和非迷走神经介导的 HRV 指数。类似地，与对照组相比，在院内感染/败血症期间观察到 HRV 降低。

只有有限的证据支持 HRV 在院内感染/败血症发展中的预测价值。即使在不同的临床条件下，降低的极低频功率 HRV 在成人中也显示出最高的预测价值。在新生儿中，心率特征评分增加，结合总功率 HRV 降低、复杂性降低以及迷走神经主导的不对称，可预测败血症。

结论

促炎症状态与 HRV 的整体降低有关，而不是迷走神经介导的 HRV 指数的单一降低，反映了炎症期间发生的复杂的自主调节变化。

使用持续 HRV 监测来检测院内感染相关状态的潜在益处以及对临床结果的影响需要进一步澄清。