Multi-scale symbolic entropy analysis provides prognostic prediction in patients receiving extracorporeal life support

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• 作者：Yen-Hung Lin (1)
  Hui-Chun Huang (1)
  Yi-Chung Chang (3)
  Chen Lin (5)
  Men-Tzung Lo (5)
  Li-Yu Daisy Liu (4)
  Pi-Ru Tsai (2)
  Yih-Sharng Chen (2)
  Wen-Je Ko (2)
  Yi-Lwun Ho (1) (8)
  Ming-Fong Chen (1)
  Chung-Kang Peng (5) (6)
  Timothy G Buchman (7)
  
  1. Department of Internal Medicine ; National Taiwan University Hospital and National Taiwan University College of Medicine ; Taipei ; Taiwan
  3. Graduate Institute of Communication Engineering ; National Taiwan University ; Taipei ; Taiwan
  5. Research Center for Adaptive Data Analysis ; National Central University ; No. 300 ; Jhongda Rd ; Taoyuan County ; 32001 ; Taiwan
  4. Department of Agronomy ; Biometry Division ; National Taiwan University ; Taipei ; Taiwan
  2. Department of Surgery ; National Taiwan University Hospital and National Taiwan University College of Medicine ; Taipei ; Taiwan
  8. Division of Cardiology ; Department of Internal Medicine ; National Taiwan University Hospital ; 7 Chung-Shan South Road ; Taipei ; Taiwan
  6. Division of Interdisciplinary Medicine and Biotechnology ; Beth Israel Deaconess Medical Center/Harvard Medical School ; Boston ; Massachusetts ; USA
  7. Department of Surgery ; Emory University School of Medicine ; Atlanta ; Georgia ; USA
  
• 刊名：Critical Care
• 出版年：2014
• 出版时间：October 2014
• 年：2014
• 卷：18
• 期：5
• 全文大小：810 KB
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• 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine;
• 出版者：BioMed Central
• ISSN：1364-8535

文摘

Introduction Extracorporeal life support (ECLS) can temporarily support cardiopulmonary function, and is occasionally used in resuscitation. Multi-scale entropy (MSE) derived from heart rate variability (HRV) is a powerful tool in outcome prediction of patients with cardiovascular diseases. Multi-scale symbolic entropy analysis (MSsE), a new method derived from MSE, mitigates the effect of arrhythmia on analysis. The objective is to evaluate the prognostic value of MSsE in patients receiving ECLS. The primary outcome is death or urgent transplantation during the index admission. Methods Fifty-seven patients receiving ECLS less than 24聽hours and 23 control subjects were enrolled. Digital 24-hour Holter electrocardiograms were recorded and three MSsE parameters (slope 5, Area 6鈥?0, Area 6鈥?0) associated with the multiscale correlation and complexity of heart beat fluctuation were calculated. Results Patients receiving ECLS had significantly lower value of slope 5, area 6 to 20, and area 6 to 40 than control subjects. During the follow-up period, 29 patients met primary outcome. Age, slope 5, Area 6 to 20, Area 6 to 40, acute physiology and chronic health evaluation II score, multiple organ dysfunction score (MODS), logistic organ dysfunction score (LODS), and myocardial infarction history were significantly associated with primary outcome. Slope 5 showed the greatest discriminatory power. In a net reclassification improvement model, slope 5 significantly improved the predictive power of LODS; Area 6 to 20 and Area 6 to 40 significantly improved the predictive power in MODS. In an integrated discrimination improvement model, slope 5 added significantly to the prediction power of each clinical parameter. Area 6 to 20 and Area 6 to 40 significantly improved the predictive power in sequential organ failure assessment. Conclusions MSsE provides additional prognostic information in patients receiving ECLS.