Quantifying EEG Combined With Heart Rate Variability For Early Prognosis Of Patients With Acute Cerebral Infarction In NICU

Objective : To investigate the value of Quantification of Electroenc-ephalography(q EEG)combined with Heart Rate Variability(HRV)in predicting the early prognosis of patients with acute cerebral infarction in the neurological intensive care unit(NICU).Methods:From July 2021 to October 2022,50 patients with acute cerebral infarction(including intravenous thrombolysis,interventional thrombectomy,and acute severe cerebral infarction)diagnosed and treated in the NICU of the Second Affiliated Hospital of Nanchang University were selected.The National Institutes of Health Stroke Scale score(NIHSS)and Glasgow Coma Score(GCS)were recorded at admission,and the modified Rankin Scale was recorded at discharge and admission.Within 24 hours after admission,the patient’s beside q EEG was monitored with a Nicoletone Monitor EEG monitor.Each case must be monitored at least once,with each monitoring lasting at least three hours.Amplitude integrated EEG(a EEG),a quantitative EEG indicator,shall be recorded.Improve the dynamic electrocardiogram examination,the standard deviation of NN interval(SDNN)within 24 hours,the root mean squared successive difference(r MSSD)within 24 hours,the mean value of the standard deviation of NN interval(SDNN index),the percent of NN50 to total number of NN intervals(PNN50),low frequency(LF),high frequency(HF)and very low frequency(VLF)were collected.According to the MRS score at discharge,patients were divided into two groups: the good prognosis group(MRS score 0-2)and the poor prognosis group(MRS score 3-6).The parameters of the amplitude integrated electroencephalogram(a EEG)and heart rate variability(SDNN,RMSSD,SDNN index,PNN50,LF,HF and VLF)were analyzed.Logistic stepwise regression analysis was used to evaluate the correlation among early prognosis in patients with acute cerebral infarction in the NICU(MRS score)and EEG and HRV.To establish the early prognosis model of patients with acute cerebral infarction in the NICU,and to evaluate and verify the predictive ability of the early prognosis model.Results:1、A total of 50 patients with acute cerebral infarction in the NICU were included,including 32 patients with a good prognosis and 18 patients with a poor prognosis.NIHSS score,MRS score and GCS score were statistically different between the two groups on admission(P=0.004,P=0.001,P=0.020),and the MRS score was statistically different at discharge(P < 0.001),there were no differences in age,sex,type of cerebral infarction,or treatment regimen(P > 0.05).2.Comparison of a EEG between the two groups: 20 cases of normal a EEG,10 cases of mild abnormality and 2 cases of severe abnormality in the good prognosis group,and 1case of normal a EEG,6 cases of mild abnormality and 11 cases of severe abnormality in the poor prognosis group.The a EEG was statistically different between the two groups(P < 0.001).3.Comparison of HRV between the two groups: there were significant differences in VLF parameters between the two groups(P < 0.001),but there were no significantly different in SDNN,SDNN index,RMSSD,PNN50,triangular index,HF and LF parameters between the two groups(P > 0.05).4.According to logistic regression analysis,the results showed that the NIHSS score,a EEG grade and VLF on admission could be used as predictors of the early prognosis of patients with acute cerebral infarction in the NICU.5.According to the construction and verification of the early prognosis model,the discrimination AUC of the NICU acute cerebral infarction prognosis model established by the modeling set was 0.9410,and the sensitivity and specificity were 90.62% and 72.22%,respectively.The internal verification was performed by the 5-repeat cross-validation method,and the AUC was 0.9115.Conclusion:QEEG combined with HRV has a good value in the predicting early prognosis of patients with acute cerebral infarction in the NICU.