Prognostic significance of heart rate trajectories on organ failure in predicted severe acute pancreatitis: secondary analysis of a randomized trial

Elevated heart rate is associated with poor clinical outcomes across various patient populations, including acute pancreatitis. This study aimed to assess whether trajectories of daily highest heart rate during the acute phase were associated with prolonged organ failure in patients with predicted severe acute pancreatitis (pSAP). This was a secondary analysis of data from a multicenter, randomized, controlled trial that assessed the effects of different crystalloids in patients with pSAP. Based on the daily highest heart rate trajectories over the first five days, patients were categorized into two groups: persistent high (PH) and transient high (TH). The primary outcome was the presence of organ failure or death on day 7. The association between different heart rate trajectories and the primary outcome was modeled with selected confounders (age, gender, BMI, etiologies, and the presence of necrosis at admission). The Multivariable Cox regression model was used to evaluate the association between heart rate trajectories and time to alive and full organ failure resolution. Overall, 183 patients were included in the analysis, of whom 41 (22.4%) were categorized in the PH group and 142 (77.6%) in the TH group. The incidence of organ failure or death on day 7 in the PH group was more than twice as high as that in the TH group (56.1% vs. 23.0%; p < 0.001). After adjustment, the results remained significant (odds ratio 3.85; 95% CIs 1.70–8.99; p = 0.001). Compared to the TH group, patients in the PH group also had a lower cumulative probability of alive and full organ failure resolution within 7 days of enrollment (hazard ratio 0.33; 95% CIs 0.14–0.77; log-rank p = 0.004). Persistent elevated heart rate during the acute phase is associated with more prolonged organ failure in patients with pSAP, indicating that early heart rate control may be a potential therapeutic strategy to improve clinical outcomes.