Autonomic Nervous System Activity and the Risk of Nosocomial Infection in Critically Ill Patients With Brain Injury
Purpose: Nosocomial infection contributes to adverse outcome after brain injury. This study investigates whether autonomic nervous system activity is associated with a decreased host immune response in patients following stroke or traumatic brain injury (TBI).
Methods: A prospective study was performed in adult patients with TBI or stroke who were admitted to the Intensive Care Unit of our tertiary university hospital between 2013 and 2016. Heart rate variability (HRV) was recorded daily and assessed for autonomic nervous system activity. Outcomes were nosocomial infections and immunosuppression, which was assessed ex vivo using whole blood stimulations with plasma of patients with infections, matched not-infected patients and healthy controls.
Results: Out of 64 brain injured patients, 23 (36%) developed an infection during their hospital stay. The ability of brain injured patients to generate a host response to LPS was diminished compared to healthy controls. Patients who developed an infection yielded significantly lower TNF-α and higher IL-10 values following ex vivo whole blood stimulations when compared to patients not developing an infection. This decreased host immune response was associated with altered admission HRV values. Brain-injured patients who developed an infection showed increased normalized high frequency power compared to patients not developing an infection, whereas normalized low frequency power was lower in infected patients.
Conclusion: Brain injured patients developing a nosocomial infection show parasympathetic predominance in the acute phase following brain injury, reflected by alterations in HRV, which parallels a decreased ability to generate an immune response to stimulation with LPS.
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Posted 22 Oct, 2020
On 25 Nov, 2020
Received 08 Nov, 2020
On 08 Nov, 2020
On 07 Nov, 2020
On 07 Nov, 2020
Received 07 Nov, 2020
On 06 Nov, 2020
Received 06 Nov, 2020
Received 06 Nov, 2020
On 28 Oct, 2020
Invitations sent on 19 Oct, 2020
On 19 Oct, 2020
On 18 Oct, 2020
On 17 Oct, 2020
On 17 Oct, 2020
On 17 Oct, 2020
Autonomic Nervous System Activity and the Risk of Nosocomial Infection in Critically Ill Patients With Brain Injury
Posted 22 Oct, 2020
On 25 Nov, 2020
Received 08 Nov, 2020
On 08 Nov, 2020
On 07 Nov, 2020
On 07 Nov, 2020
Received 07 Nov, 2020
On 06 Nov, 2020
Received 06 Nov, 2020
Received 06 Nov, 2020
On 28 Oct, 2020
Invitations sent on 19 Oct, 2020
On 19 Oct, 2020
On 18 Oct, 2020
On 17 Oct, 2020
On 17 Oct, 2020
On 17 Oct, 2020
Purpose: Nosocomial infection contributes to adverse outcome after brain injury. This study investigates whether autonomic nervous system activity is associated with a decreased host immune response in patients following stroke or traumatic brain injury (TBI).
Methods: A prospective study was performed in adult patients with TBI or stroke who were admitted to the Intensive Care Unit of our tertiary university hospital between 2013 and 2016. Heart rate variability (HRV) was recorded daily and assessed for autonomic nervous system activity. Outcomes were nosocomial infections and immunosuppression, which was assessed ex vivo using whole blood stimulations with plasma of patients with infections, matched not-infected patients and healthy controls.
Results: Out of 64 brain injured patients, 23 (36%) developed an infection during their hospital stay. The ability of brain injured patients to generate a host response to LPS was diminished compared to healthy controls. Patients who developed an infection yielded significantly lower TNF-α and higher IL-10 values following ex vivo whole blood stimulations when compared to patients not developing an infection. This decreased host immune response was associated with altered admission HRV values. Brain-injured patients who developed an infection showed increased normalized high frequency power compared to patients not developing an infection, whereas normalized low frequency power was lower in infected patients.
Conclusion: Brain injured patients developing a nosocomial infection show parasympathetic predominance in the acute phase following brain injury, reflected by alterations in HRV, which parallels a decreased ability to generate an immune response to stimulation with LPS.
Figure 1
Figure 2
Figure 3