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Analysis of heart rate variability in critical septic patients using a smartphone application: a prospective cohort study
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DOI：10.3389/fmed.2026.1877291.png)
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Abstract
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IntroductionHeart rate variability (HRV) reflects autonomic nervous system modulation and has been associated with mortality in sepsis. However; in the intensive care unit (ICU); HRV assessment with traditional equipment limits its use. This study aimed to investigate the association between HRV measured by a mobile application and mortality in septic patients.MethodsThis is a prospective observational cohort study conducted in two ICUs in Curitiba; Brazil; between July 2024 and March 2026; including septic patients (≥18 years) within 24 h of sepsis diagnosis. HRV; assessed using the standard deviation of NN intervals (SDNN); was measured through a heart rate monitor strap for 5 min over 3 consecutive days; clinical and hemodynamic data were also collected. Pregnancy; patients in exclusive palliative care; skin lesions that could interfere with the cardiac sensor; and decompensated irregular heart rhythm signs during data collection were excluded. The primary outcome was 28-day mortality.ResultsA total of 112 septic patients were included; with an overall 28-day mortality of 49%. Non-survivors had a significantly higher APACHE II (30 vs. 22; p < 0; 001); and SDNN values were also significantly lower in non-survivors at 72 h (9.4 ms vs 11.3 ms; p = 0; 027). Additionally; in multivariable analysis; female sex; age; SOFA score; capillary refill time (CRT); and SDNN < 5 ms were independently associated with mortality.ConclusionHRV assessed by a mobile application demonstrated a significant association with 28-day mortality in septic patients; with lower SDNN values at 72 h. This method might facilitate the wider implementation of HRV monitoring in resource-limited ICUs to stratify mortality in septic patients.
Keywords:
mobile health
heart rate variability
mortality
autonomic nervous system
sepsis
wearable device
intensive care unit
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