Relation of heart rate variability to serum levels of C-reactive protein, interleukin 6, and 10 in patients with sepsis and septic shock

Abstract 

Purpose

The aim of the study was to investigate possible associations between different heart rate variability (HRV) indices and various biomarkers of inflammation in 45 septic patients.

Materials and Methods

We daily assessed HRV in the time domain (SD of RR intervals [SDNN]), frequency domain (low [LF], high frequency [HF], LF/HF as an indicator of sympathovagal balance); the 2 values of SD (SD1, SD2) from the Poincaré plot; and measured C-reactive protein, interleukin 6, and interleukin 10 serum levels in patients with sepsis and mean Sequential Organ Failure Assessment score (SOFA) 10 or lower (n = 25) and septic shock (SOFA > 10, n = 20) for 6 days.

Results

C-reactive protein exhibited significant negative correlations with LF (r = −0.78), LF/HF (r = −0.61), and SDNN (r = −0.79) and positive correlations with HF (r = 0.80) and SD1/SD2 (r = 0.66), whereas interleukin 10 was positively correlated with HF (r = 0.71) and negatively with LF (r = −0.89) and LF/HF (r = −0.66) in septic shock patients (P < .05 for all comparisons). Standard deviation of RR intervals and HF proved to be independent predictors of the severity of disease (β slope [B] = −1.091; P = .013; 95% confidence interval [CI], −1.43 to −0.74, and B = 0.78; P = .022; 95% CI, 0.21-1.35, respectively).

Conclusions

Our data suggest that low HRV and sympathovagal balance during septic shock are associated with both an increased hyperinflammatory and antiinflammatory response.

Keywords: Autonomic nervous system, C-reactive protein, Cytokine, Heart rate variability, Inflammation