ABSTRACT

Sepsis causes a series of pathological changes in the systems such as cardiovascular, respiratory, and thermoregulation. These changes cause alterations in heart rate variability (HRV). Even without any changes in the vital signs or clinical presentation of the disease, HRV may still be altered due to sympathetic nervous system activation caused by infection. Our aim in this review was to present the sepsis-related HRV measures and parameters by examining the literature and their possible role in the predicting severity and mortality of sepsis. Databases were searched for original research articles reporting human studies with HRV on sepsis, published in the English language between April 1996 – May 2023. After completion of the article search, a total of 79 articles were selected for further evaluation where the full text of the articles was reviewed and 13 of the articles meet the criteria for inclusion. Mean values of each HRV parameter were corrected to the sample size of each study and overall means were calculated accordingly. Statistical comparisons were performed after sample size correction by Willcoxon signed ranked test. Nine studies were included, with a total of 1453 patients, the weighted mean age was 64.24 years and 53.9% were male. Of the studies included, all performed frequency domain analysis, and four performed nonlinear analysis. Seven out of nine studies were conducted in emergency departments and two were in intensive care units of the hospitals. 6 studies compared parameters between survivors and non-survivors, and 3 studies compared between different severity levels of sepsis. SDNN, RMSSD, SDNN, HTI, LF (nu), HF (nu), LF/HF ratio, SD1, SD2, DFAα1, and DFAα2 appear to be related to mortality in patients with sepsis outcome. Therefore, it can be concluded that monitoring these parameters for the early detection of sepsis may be beneficial.