Heart rate variability - a potential early marker of sub-acute post-stroke infections

Acta Neurol Scand. 2012 Sep;126(3):189-96. doi: 10.1111/j.1600-0404.2011.01626.x. Epub 2011 Nov 25.


Objective: Infection is the most relevant complication after acute ischemic stroke. Activity of the autonomic nervous system seems to control post-stroke immunodepression. We investigated heart rate variability (HRV) indices that reflect autonomic readjustments as predictors of post-stroke infection.

Materials and methods: Forty-three patients with acute ischemic stroke were enrolled in a prospective study. The predictability of sub-acute infections (day 4 ± 1 after admission) was investigated in 34 patients without acute infection by means of HRV indices obtained in the acute period (48 h after admission).

Results: Sub-acute infection could be predicted in patients without clinical or paraclinical (white blood cell count and C-reactive protein) signs of infection in the acute period at (i) day: increased HFnorm, reduced LFnorm and LF/HF; (ii) night: reduced LF and VLF (P < 0.05).

Conclusions: HRV indices are candidates for early markers of developing post-stroke infections, preceding routine blood samples. Thus, HRV-based early diagnosis of post-stroke infection should be investigated in more detail as it may have implications as a novel tool for timely and appropriate treatment. A corresponding continuous HRV-based risk assessment using the ECG provided by the routine stroke monitoring system would be possible without any additional burden for patients and staff.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Autonomic Nervous System / physiopathology*
  • Blood Glucose
  • Blood Pressure
  • C-Reactive Protein / metabolism
  • Female
  • Heart Rate / physiology*
  • Humans
  • Infections / diagnosis*
  • Infections / etiology*
  • Leukocyte Count
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prospective Studies
  • ROC Curve
  • Stroke / complications*


  • Blood Glucose
  • C-Reactive Protein