Autonomic impairment of patients in coma with different Glasgow coma score assessed with heart rate variability


Primary objective: The objective of this study is to assess the functional state of the autonomic nervous system in healthy individuals and in individuals in coma using measures of heart rate variability (HRV) and to evaluate its efficiency in predicting mortality. Design and Methods: Retrospective group comparison study of patients in coma classified into two subgroups, according to their Glasgow coma score, with a healthy control group. HRV indices were calculated from 7 min of artefact-free electrocardiograms using the Hilbert–Huang method in the spectral range 0.02–0.6 Hz. A special procedure was applied to avoid confounding factors. Stepwise multiple regression logistic analysis (SMLRA) and ROC analysis evaluated predictions. Results: Progressive reduction of HRV was confirmed and was associated with deepening of coma and a mortality score model that included three spectral HRV indices of absolute power values of very low, low and very high frequency bands (0.4-0.6 Hz). The SMLRA model showed sensitivity of 95.65%, specificity of 95.83%, positive predictive value of 95.65%, and overall efficiency of 95.74%. Conclusions: HRV is a reliable method to assess the integrity of the neural control of the caudal brainstem centres on the hearts of patients in coma and to predict patient mortality.

Publication DOI:
Divisions: College of Health & Life Sciences > School of Optometry > Audiology
College of Health & Life Sciences
Additional Information: This is an Accepted Manuscript of an article published by Taylor & Francis Group in Brain Injury on 12 Feb 2019, available online at:
Uncontrolled Keywords: autonomic nervous system,coma,Glasgow coma scale,Heart rate variability,Hilbert–Huang transform,Neuroscience (miscellaneous),Developmental and Educational Psychology,Clinical Neurology
Publication ISSN: 1362-301X
Last Modified: 09 May 2024 07:12
Date Deposited: 20 Feb 2019 15:41
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Related URLs: https://www.tan ... 52.2018.1553312 (Publisher URL)
http://www.scop ... tnerID=8YFLogxK (Scopus URL)
PURE Output Type: Article
Published Date: 2019-03-21
Published Online Date: 2019-02-12
Accepted Date: 2018-11-25
Authors: Estévez-báez, Mario
Machado, Calixto
García-sánchez, Benjamín
Rodríguez, Valia (ORCID Profile 0000-0002-6085-285X)
Alvarez-santana, Reynaldo
Leisman, Gerry
Carrera, José Mario Estévez
Schiavi, Adam
Montes-brown, Julio
Arrufat-pié, Eduardo



Version: Accepted Version

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