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Autonomic Nervous System Activity and the Risk of Nosocomial Infection in Critically Ill Patients With Brain Injury
Mathijs Wirtz
Department of Intensive Care Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, and The Laboratory of Experimental Intensive Care and Anesthesiology of the Amsterdam University Medical Center, Amsterdam, The Netherlands.
Corresponding Author
ORCiD: https://orcid.org/0000-0002-1923-083X
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at Intensive Care Medicine Experimental.
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.
Keywords
Autonomic nervous system, Brain injury, Immunosuppression, Nosocomial infection
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CURRENT STATUS: Published
Version 1
Posted 22 Oct, 2020
Published
On 25 Nov, 2020
No community comments so far
Review #1 received
Received 08 Nov, 2020
Editorial decision: Minor revision
On 08 Nov, 2020
Reviewer #5 agreed
On 07 Nov, 2020
Reviewer #4 agreed
On 07 Nov, 2020
Review #4 received
Received 07 Nov, 2020
Reviewer #3 agreed
On 06 Nov, 2020
Review #3 received
Received 06 Nov, 2020
Review #2 received
Received 06 Nov, 2020
Reviewer #2 agreed
On 28 Oct, 2020
Reviewers invited
Invitations sent on 19 Oct, 2020
Reviewer #1 agreed
On 19 Oct, 2020
Editor assigned
On 18 Oct, 2020
First submitted
On 17 Oct, 2020
Submission checks complete
On 17 Oct, 2020
Editor invited
On 17 Oct, 2020
Metrics
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This preprint is under consideration at Intensive Care Medicine Experimental. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Autonomic Nervous System Activity and the Risk of Nosocomial Infection in Critically Ill Patients With Brain Injury
Mathijs Wirtz
Department of Intensive Care Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, and The Laboratory of Experimental Intensive Care and Anesthesiology of the Amsterdam University Medical Center, Amsterdam, The Netherlands.
Corresponding Author
ORCiD: https://orcid.org/0000-0002-1923-083X
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 1
Posted 22 Oct, 2020
Published
On 25 Nov, 2020
No community comments so far
Review #1 received
Received 08 Nov, 2020
Editorial decision: Minor revision
On 08 Nov, 2020
Reviewer #5 agreed
On 07 Nov, 2020
Reviewer #4 agreed
On 07 Nov, 2020
Review #4 received
Received 07 Nov, 2020
Reviewer #3 agreed
On 06 Nov, 2020
Review #3 received
Received 06 Nov, 2020
Review #2 received
Received 06 Nov, 2020
Reviewer #2 agreed
On 28 Oct, 2020
Reviewers invited
Invitations sent on 19 Oct, 2020
Reviewer #1 agreed
On 19 Oct, 2020
Editor assigned
On 18 Oct, 2020
First submitted
On 17 Oct, 2020
Submission checks complete
On 17 Oct, 2020
Editor invited
On 17 Oct, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at Intensive Care Medicine Experimental.
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