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

Lin YH, Huang HC, Chang YC, Lin C, Lo MT, Liu LY, Tsai PR, Chen YS, Ko WJ, Ho YL, Chen MF, Peng CK, Buchman TG - Crit Care (2014)

Bottom Line: 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.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.Area 6 to 20 and Area 6 to 40 significantly improved the predictive power in sequential organ failure assessment.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan. austinr34@gmail.com.

ABSTRACT

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 hours and 23 control subjects were enrolled. Digital 24-hour Holter electrocardiograms were recorded and three MSsE parameters (slope 5, Area 6-20, Area 6-40) 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.

Show MeSH

Related in: MedlinePlus

Receiver-operator characteristic curves for models with (solid line) and without slope 5 (broken line). The area under the curve (AUC) for sequential organ failure assessment SOFA was 0.637. After adding slope 5, the AUC of the new model improved to 0.749.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4221713&req=5

Fig4: Receiver-operator characteristic curves for models with (solid line) and without slope 5 (broken line). The area under the curve (AUC) for sequential organ failure assessment SOFA was 0.637. After adding slope 5, the AUC of the new model improved to 0.749.

Mentions: In ROC analyses (Table 5), slope 5 had the largest area under the curve (AUC) among MSsE parameters; the LODS had the largest AUC among clinical severity scores. When combining MSsE parameters with measures of clinical severity, AUC improved outcome prediction. Among the MSsE parameters, slope 5 added the largest improvement. For example (see Figure 4), the AUC for SOFA was 0.637. After adding slope 5, the AUC for the new model improved to 0.749.Figure 4


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

Lin YH, Huang HC, Chang YC, Lin C, Lo MT, Liu LY, Tsai PR, Chen YS, Ko WJ, Ho YL, Chen MF, Peng CK, Buchman TG - Crit Care (2014)

Receiver-operator characteristic curves for models with (solid line) and without slope 5 (broken line). The area under the curve (AUC) for sequential organ failure assessment SOFA was 0.637. After adding slope 5, the AUC of the new model improved to 0.749.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4221713&req=5

Fig4: Receiver-operator characteristic curves for models with (solid line) and without slope 5 (broken line). The area under the curve (AUC) for sequential organ failure assessment SOFA was 0.637. After adding slope 5, the AUC of the new model improved to 0.749.
Mentions: In ROC analyses (Table 5), slope 5 had the largest area under the curve (AUC) among MSsE parameters; the LODS had the largest AUC among clinical severity scores. When combining MSsE parameters with measures of clinical severity, AUC improved outcome prediction. Among the MSsE parameters, slope 5 added the largest improvement. For example (see Figure 4), the AUC for SOFA was 0.637. After adding slope 5, the AUC for the new model improved to 0.749.Figure 4

Bottom Line: 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.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.Area 6 to 20 and Area 6 to 40 significantly improved the predictive power in sequential organ failure assessment.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan. austinr34@gmail.com.

ABSTRACT

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 hours and 23 control subjects were enrolled. Digital 24-hour Holter electrocardiograms were recorded and three MSsE parameters (slope 5, Area 6-20, Area 6-40) 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.

Show MeSH
Related in: MedlinePlus