{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T22:52:39Z","timestamp":1788648759061,"version":"build-2803163510"},"reference-count":28,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,8,5]],"date-time":"2022-08-05T00:00:00Z","timestamp":1659657600000},"content-version":"vor","delay-in-days":216,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acute Medicine &amp; Surgery"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:sec><jats:title>Aim<\/jats:title><jats:p>It remains unclear how autonomic regulation modulates pathophysiological changes of sepsis. This study aims to analyze and clarify those in patients with suspected sepsis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this single\u2010centered, prospective, observational study, adult patients who had an infection, a quick Sequential Organ Failure Assessment score of 2 or more at the emergency department, and underwent intensive care were screened. Heart rate variability (HRV) and serum adrenaline were measured immediately after arrival. The primary outcome was defined as vasopressor dependence during 48\u2009h after arrival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 63 patients were included. All the patients had SOFA score of 2 or more on admission. Vasopressor dependence, renal replacement therapy, and in\u2010hospital mortality were associated with higher adrenaline (which reflects sympathetic adrenergic system activity). Bacteremia was associated with lower high\u2010frequency components of HRV (parasympathetic nerve activity). The HRV parameter of sympathetic nerve activity had no significant association with the outcomes. In the multivariate logistic regression model adjusted for age and sex, vasopressor dependence remained associated with higher adrenaline (cut\u2010off 0.11\u2009ng\/mL, odds ratio 9.71, 95% confidence interval 2.55\u201337; <jats:italic>P<\/jats:italic>\u2009=\u20090.000874), and lower high\u2010frequency components with bacteremia (17.2\u2009ms<jats:sup>2<\/jats:sup>, odds ratio 4.86, 95% confidence interval 1.36\u201317.4; <jats:italic>P<\/jats:italic>\u2009=\u20090.0152). There were no significant correlations between parameters of HRV and serum adrenaline.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Hypoperfusion, organ dysfunction, and in\u2010hospital mortality were associated with an increased sympathetic adrenergic activity. Bacteremia was associated with decreased parasympathetic nerve activity. The autonomic regulator may involve a multilayered and differentiated modulating process for sepsis.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ams2.776","type":"journal-article","created":{"date-parts":[[2022,8,5]],"date-time":"2022-08-05T10:14:49Z","timestamp":1659694489000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Exploration of autonomic regulation reflecting on pathophysiological change of sepsis: a prospective observational study"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6336-1159","authenticated-orcid":false,"given":"Ryuta","family":"Nakashima","sequence":"first","affiliation":[{"name":"Graduate School of Medical Sciences Kumamoto University  Kumamoto City Kumamoto Japan"},{"name":"Department of Emergency and Intensive Care Medicine Oita City Medical Association's Almeida Memorial Hospital  Oita City Oita Japan"},{"name":"Department of Emergency Medicine Oita Prefecture Saiseikai Hita Hospital  Hita City Oita Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuhiro","family":"Inagaki","sequence":"additional","affiliation":[{"name":"Department of Emergency and Intensive Care Medicine Oita City Medical Association's Almeida Memorial Hospital  Oita City Oita Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunji","family":"Kasaoka","sequence":"additional","affiliation":[{"name":"Disaster Medical Education and Research Center Kumamoto University Hospital  Kumamoto City Kumamoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,8,5]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brainres.2008.11.053"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.fjc.0000154372.03531.e1"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10286-020-00714-0"},{"key":"e_1_2_9_5_1","first-page":"111","article-title":"Adrenomedullary, adrenocortical, and sympathoneural responses to stressors: a meta\u2010analysis","volume":"42","author":"Goldstein DS","year":"2008","journal-title":"Endocr. 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