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Slowing down of recovery as generic risk marker for acute severity transitions in chronic diseases

TitleSlowing down of recovery as generic risk marker for acute severity transitions in chronic diseases
Publication TypeJournal Article
Year of Publication2016
AuthorsRikkert M, Dakos V., Buchman T.G, de Boer R., Glass L., Cramer A.OJ, Levin S., van Nes E., Sugihara G, Ferrari M.D, Tolner E.A, van de Leemput I., Lagro J., Melis R., Scheffer M.
JournalCritical Care Medicine
Date Published2016/03
Type of ArticleReview
ISBN Number0090-3493
Accession NumberWOS:000371528700018
Keywordscritical slowing down; early-warning signals; mechanical ventilation; nonlinear dynamics; Onset; recovery of function; resilience; systems; tipping point

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.

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