Heart rate circadian rhythm in patients with traumatic brain injury: A retrospective analysis of a nationwide multicenter ICU database

Apr 6, 2026American heart journal plus : cardiology research and practice

Daily patterns of heart rate in patients with traumatic brain injury in intensive care

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Abstract

Each 10-beat/min increase in heart rate mesor is associated with a 1.18-fold higher odd of in-hospital mortality among patients with traumatic brain injury (TBI).

A 5-beat/min increase in heart rate amplitude is linked to a 1.14-fold increase in the odds of in-hospital mortality.
The relationship between heart rate mesor and in-hospital mortality varies based on comorbidities, including heart failure and atrial fibrillation.
Circadian rhythm metrics improve the prognostic accuracy of the APACHE IV score, raising the model's discrimination ability from 0.719 to 0.795.
Findings suggest that heart rate circadian rhythm features could be independent prognostic factors for TBI patients.

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OBJECTIVE: This study aimed to determine whether the circadian rhythm in heart rate independently associated with in-hospital mortality among patients with TBI.

METHODS: Data were extracted from the eICU-CRD. Heart rate circadian rhythm was characterized using three parameters: mesor, amplitude, and peak time. The prognostic association and incremental discriminatory value of these circadian variables, alongside the APACHE IV score, was assessed in relation to in-hospital mortality.

RESULTS: Among 3202 patients showing a circadian rhythm in heart rate, each 10-beat/min increase in mesor was associated with a 1.18-fold higher odd of in-hospital mortality (95% CI: 1.08-1.30; < 0.001), while each 5-beat/min increase in amplitude corresponded to a 1.14-fold increase (95% CI: 1.03-1.25; < 0.001). The link between mesor and in-hospital mortality varied with comorbidities such as heart failure ( = 0.039), atrial fibrillation ( = 0.014), infection ( = 0.003), and fever ( = 0.027). Adding circadian rhythm metrics to the APACHE IV score improved model discrimination (c-index 0.795; 95% CI: 0.747-0.844) compared to APACHE IV alone (c-index 0.719; 95% CI: 0.665-0.773; < 0.001). P P P P P P P

CONCLUSION: Circadian rhythm features of heart rate are independent prognostic factors associated with in-hospital mortality in TBI patients. Integrating these variables with conventional scoring systems may improve prognostic accuracy.

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Heart rate circadian rhythm in patients with traumatic brain injury: A retrospective analysis of a nationwide multicenter ICU database

Abstract

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