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Heart rate variability is associated with encephalopathy and outcomes in pediatric acute liver failure
Tricia R Pendergrast1, Catherine A Chapin2, Alyssa A Kriegermeier2
1Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Insights
Heart rate variability (HRV) may help predict outcomes in children with pediatric acute liver failure (PALF) and hepatic encephalopathy (HE). Lower HRV was linked to worse HE and poorer clinical outcomes in this study.
Area of Science:
- Pediatric critical care medicine
- Hepatology
- Autonomic nervous system function
Background:
- Pediatric acute liver failure (PALF) affects many children, often leading to hepatic encephalopathy (HE).
- Diagnosing HE in children is challenging, impacting patient outcomes.
- Autonomic nervous system dysfunction, measured by heart rate variability (HRV), is a potential indicator.
Purpose of the Study:
- To investigate the association between HRV and the presence/severity of HE in children with PALF.
- To determine if HRV can predict clinical outcomes in pediatric patients with acute liver failure.
Main Methods:
- Retrospective observational cohort study of 38 critically ill children with PALF.
- Integer heart rate variability (HRVi) was used to assess autonomic function.
- Statistical analyses included Fisher Exact test, Kruskal-Wallis tests, and Pearson's correlation to evaluate associations.
Main Results:
- Lower median and minimum HRVi values, indicating poorer autonomic function, were significantly associated with abnormal EEG findings.
- Reduced HRVi correlated with the presence and severity of hepatic encephalopathy.
- Poorer HRV was linked to adverse clinical outcomes, including death or need for liver transplant.
Conclusions:
- Heart rate variability shows potential as a prognostic tool in pediatric acute liver failure.
- Further validation in larger patient cohorts is needed to confirm these findings.
- HRV could aid in early risk stratification for severe HE and guide decisions on liver transplantation.
Background:
More than half of children with pediatric acute liver failure (PALF) experience hepatic encephalopathy (HE), which is related to poor outcomes; however, HE is difficult to diagnose in children. The objective of this study was to evaluate if heart rate variability (HRV), a continuous measure of autonomic nervous system function, was related to the presence and severity of HE as well as clinical outcomes in children with PALF.
Methods:
We conducted a retrospective observational cohort study of 38 critically ill children with PALF to examine the association between HRV and HE severity and clinical outcome. HRV was estimated using the integer HRV (HRVi). Categorical variables were compared using the Fisher Exact test and continuous variables were compared using Kruskal-Wallis tests. Associations between grades of HE and minimum and median HRVi were evaluated with Pearson's correlation, with p values <0.05 considered significant.
Results:
A more negative median and minimum HRVi, indicating poorer autonomic nervous system function, was significantly associated with abnormal EEG findings, presence of HE, and poor outcomes (death or listing for transplant).
Conclusions:
Heart rate variability may hold promise to predict outcomes in children with PALF, but these findings should be replicated in a larger sample.
Impact:
The findings of our study suggest that heart rate variability is associated with clinical outcomes in children with acute liver failure, a cohort for which prognostics are challenging, especially in young children and infants. Use of heart rate variability in the clinical setting may facilitate earlier detection of children with pediatric acute liver failure (PALF) at high risk for severe hepatic encephalopathy and poor outcomes. Identification of children with PALF at high risk of decompensation may assist clinicians in making decisions about liver transplantation, an important, but resource-limited, treatment of PALF.
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