Influence of heart rate trajectory in 30-day mortality in sepsis patients: a retrospective study based on the MIMIC-IV database

BMC Infect Dis. 2025 Dec 9;25(1):1702. doi: 10.1186/s12879-025-11961-9.

ABSTRACT

BACKGROUND: Heart rate is one of the important vital signs. Many studies have done a lot of meaningful research on heart rate in sepsis patients. However, the heart rates of sepsis patients were repeatedly measured after their admission to intensive care unit (ICU). The trajectory of these changes was observed, but the impact of this trajectory on the short-term mortality prognosis for sepsis remains unclear. This study was performed to investigate impact of repeated changes in heart rate on short-term all-cause mortality among sepsis patients was assessed.

METHOD: In this retrospective study of data on sepsis patients from the Medical Information Mart for Intensive Care (MIMIC) IV database, the outcome was short-term mortality. The measured heart rate of sepsis patients 10 h post-admission to ICU was extracted, with 1 h between each measurement. Latent growth mixture modelling (LGMM) was used to classify heart rate trajectories, while Kaplan-Meier (K-M) and Cox proportional hazards models were employed to analyze differences in survival between groups.

RESULT: This study enrolled 5511 sepsis patients, and six different heart rate trajectories were identified based on model-fit criteria. Class 1: heart rate stable at 80 bpm; class 2: consistently 92 bpm; class 3: briefly stable, then declining; class 4: steady at 110 bpm; class 5: fluctuating around 65 bpm; class 6: stable at 128 bpm. The K-M analysis indicated sepsis patients in class1 had the highest survival probability, and the class3 had the lowest survival probability. After adjusting for all potential confounding factors, the Cox proportional hazard model showed that compared with class 1, the hazard ratios (HRs) with 95% confidence intervals (CIs) for classes 2, 3, 4, 5, and 6 were 1.28 (1.09, 1.50), 1.88 (1.38, 2.56), 1.49 (1.26, 1.76), 1.24 (1.03, 1.48), and 1.30 (1.02, 1.66), respectively.

CONCLUSIONS: Maintaining a sustained heart rate of approximately 80 beats per minute during the initial 10-hour period post-ICU admission may be associated with improved short-term outcomes in patients with sepsis.

PMID:41366739 | DOI:10.1186/s12879-025-11961-9