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  • Clinical Research Article
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Cardiovascular responses as predictors of mortality in children with acute brain injury

Pediatric Research volume 97, pages 2347–2353 (2025)Cite this article

Abstract

Background

Investigate the utility of cardiovascular responses such as heart rate (HR), blood pressure (BP), and heart rate variability (HRV) in the prognosis of children with acute acquired brain injury (ABI).

Methods

Children under 18 years with severe acute acquired brain injury (ABI) who survived at least 12 h after PICU admission were included in a prospective observational cohort in a tertiary academic PICU. Physiological variables, neurological data, laboratory tests (chemistry and hematology), and medications were recorded within 12 h of admission. Linear and nonlinear HRV indices, CT scans, PICU scores, and survival rates were evaluated.

Results

Seventy-two children, median age 10.7 years (IQR 4.1–13.6), were eligible for the study; 28 (38.9%) were diagnosed with brain death (BD). Tachycardia, SBP and MBP < 5th percentile, and MBP and DBP> 99th percentile were significantly associated with mortality. Poincaré SD1/SD2 was significantly associated with mortality after adjusting for age, sex and ongoing medication.

Conclusion

Tachycardia, systolic hypotension and median hypo and hypertension were associated to mortality in children with severe ABI. While further validation through larger, multicenter studies is necessary, the Poincaré SD1/SD2 ratio has shown promise as a prognostic tool for predicting mortality in children with severe ABI.

Impact statement

  • This study explores cardiovascular changes, including heart rate and blood pressure, and linear/nonlinear HRV measures using ECG at 1000 Hz, and compare them with other prognostic factors like brain tomography and PICU scores. Tachycardia, hypo/hypertension in the early hours after admission are linked to early mortality in children with severe traumatic and non-traumatic brain injury. Linear/non-linear measures of HRV were also related to survival. Higher HRV values indicating better survival chances. We identified Poincaré SD1/SD2 ratio as a promising tool for predicting mortality in children with severe ABI.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

A.P.R., partially supported by CMUP, member of LASI, which is financed by national funds through FCT—Fundação para a Ciência e a Tecnologia, I.P., under the projects with reference UIDB/00144/2020 and UIDP/00144/2020.

Author information

Authors and Affiliations

  1. Pediatric Intensive Care Unit, São João University Hospital Center, Porto, Portugal

    Marta João Silva

  2. Ginecology-Obstetrics and Pediatrics Department, Faculty of Medicine, University of Porto, Porto, Portugal

    Marta João Silva, Maria João Baptista & Inês Azevedo

  3. CINTESIS@RISE, Faculty of Medicine, University of Porto, Porto, Portugal

    Marta João Silva, Hernâni Gonçalves, Rute Almeida, Claúdia Camila Dias, Cristina Granja & Inês Azevedo

  4. Mathematics Center, University of Porto, Porto, Portugal

    Marta João Silva, Rute Almeida & Ana Paula Rocha

  5. Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal

    Hernâni Gonçalves & Rute Almeida

  6. Knowledge Management Unit, Faculty of Medicine, University of Porto, Porto, Portugal

    Claúdia Camila Dias

  7. Neuroradiology Department, São João University Hospital Center, Porto, Portugal

    Ana Isabel Almeida

  8. Department of Mathematics, Faculty of Sciences, University of Porto, Porto, Portugal

    Ana Paula Rocha

  9. Anaesthesiology Department, São João University Hospital Center, Porto, Portugal

    Cristina Granja

  10. Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal

    Cristina Granja

  11. Pediatric Cardiology Department, São João University Hospital Center, Porto, Portugal

    Maria João Baptista

  12. Pediatric Department, São João University Hospital Center, Porto, Portugal

    Inês Azevedo

Authors
  1. Marta João Silva
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  8. Maria João Baptista
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  9. Inês Azevedo
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Contributions

Substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data—M.J.S.; H.G.; R.A.; C.C.D.; A.I.A.; C.G.; A.P.R.;I.A. Drafting the article or revising it critically for important intellectual content—M.J.S.; M.J.B.; C.G.; R.A.; H.G.; C.C.D. Final approval of the version to be published—M.J.S.; I.A.; C.G.; M.J.B.; A.P.R.; R.A.; C.C.D.; H.G.

Corresponding author

Correspondence to Marta João Silva.

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Silva, M.J., Gonçalves, H., Almeida, R. et al. Cardiovascular responses as predictors of mortality in children with acute brain injury. Pediatr Res 97, 2347–2353 (2025). https://doi.org/10.1038/s41390-024-03679-2

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