Slowing Down of Recovery as Generic Risk Marker for Acute Severity Transitions in Chronic Diseases.
Crit Care Med
; 44(3): 601-6, 2016 Mar.
Article
em En
| MEDLINE
| ID: mdl-26765499
ABSTRACT
OBJECTIVE:
We propose a novel paradigm to predict acute attacks and exacerbations in chronic episodic disorders such as asthma, cardiac arrhythmias, migraine, epilepsy, and depression. A better generic understanding of acute transitions in chronic dynamic diseases is increasingly important in critical care medicine because of the higher prevalence and incidence of these chronic diseases in our aging societies. DATA SOURCES PubMed, Medline, and Web of Science. STUDY SELECTION We selected studies from biology and medicine providing evidence of slowing down after a perturbation as a warning signal for critical transitions. DATA EXTRACTION Recent work in ecology, climate, and systems biology has shown that slowing down of recovery upon perturbations can indicate loss of resilience across complex, nonlinear biologic systems that are approaching a tipping point. This observation is supported by the empiric studies in pathophysiology and controlled laboratory experiments with other living systems, which can flip from one state of clinical balance to a contrasting one. We discuss examples of such evidence in bodily functions such as blood pressure, heart rate, mood, and respiratory regulation when a tipping point for a transition is near.CONCLUSIONS:
We hypothesize that in a range of chronic episodic diseases, indicators of critical slowing down, such as rising variance and temporal correlation, may be used to assess the risk of attacks, exacerbations, and even mortality. Identification of such early warning signals over a range of diseases will enhance the understanding of why, how, and when attacks and exacerbations will strike and may thus improve disease management in critical care medicine.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Doença Crônica
/
Medição de Risco
/
Cuidados Críticos
Tipo de estudo:
Etiology_studies
/
Prognostic_studies
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Risk_factors_studies
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Systematic_reviews
Limite:
Humans
Idioma:
En
Revista:
Crit Care Med
Ano de publicação:
2016
Tipo de documento:
Article