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The Prognostic Correlation of Heart Rate Variability at Diagnosis with Survival of Patients with Hepatocellular
Ana-Maria Ciurea1, Dan Ionuț Gheonea2, Michael Schenker1
1Department of Oncology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
Insights
Heart rate variability (HRV) can predict survival in hepatocellular carcinoma (HCC) patients. Low SDNN values (< 110 ms) were identified as an independent risk factor for overall survival in HCC patients.
Area of Science:
- Cardiology
- Oncology
- Medical Informatics
Background:
- Heart rate variability (HRV) indices are linked to prognosis in various cancers.
- Hepatocellular carcinoma (HCC) survival prediction is crucial for patient management.
Purpose of the Study:
- To evaluate the predictive capability of HRV indices for survival in HCC patients.
- To identify potential noninvasive biomarkers for HCC prognosis.
Main Methods:
- Retrospective analysis of 231 HCC patients diagnosed between January 2014 and March 2018.
- Analysis of baseline clinical-pathological variables and HRV indices from Holter ECG recordings.
- Univariate and multivariate Cox regression analyses for overall survival (OS) prediction.
Main Results:
- Age > 60, hepatitis C, portal vein involvement, tumor size > 5 cm, high AFP, low albumin, and high CRP were risk factors for poor OS.
- Tumor size > 5 cm and AFP > 400 ng/mL independently predicted poorer outcomes.
- SDNN < 110 ms was an independent risk factor for OS (HR 3.646, 95% CI 2.143 to 6.205).
Conclusions:
- HRV indices can identify HCC patients at high risk of mortality.
- HRV monitoring may guide early therapeutic interventions in HCC patients.
- HRV shows potential as a noninvasive biomarker for HCC prognosis.
Background:
Heart rate variability (HRV) indices have been shown to be associated with prognosis in various types of cancer. This study aims to assess the ability of these indices to predict survival in hepatocellular carcinoma (HCC) patients after diagnosis.
Methods:
We retrospectively collected data from 231 patients diagnosed with HCC between January 2014 and March 2018. The baseline clinical-pathological variables and HRV indices (extracted from Holter electrocardiogram recordings) were analyzed.
Results:
Univariate and multivariate analyses were performed to identify the predictive value of the above factors for overall survival (OS). The univariate analysis revealed that an age > 60 years, hepatitis C, portal vein involvement (thrombosis), a tumor size > 5 cm, alpha-fetoprotein (AFP) > 400 ng/mL, serum albumin, and C-reactive protein (CRP) were risk factors for poor OS. Multivariable Cox regression analyses identified that a tumor size > 5 cm and AFP > 400 ng/mL predict poorer outcomes in HCC patients. It should be mentioned that, in both the univariate analysis and in the multivariate analysis, between HRV indices, SDNN (standard deviation of all normal-to-normal (NN) intervals) < 110 ms was an independent risk factor for OS with an HR of 3.646 (95% CI 2.143 to 6.205).
Conclusion:
This study demonstrates that HRV indices identify HCC patients at high risk of death and suggests that such monitoring might guide the need for early therapy in these types of patients, as well as the fact that HRV can be a potential noninvasive biomarker for HCC prognosis.
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