TY - JOUR
T1 - Slowing Down of Recovery as Generic Risk Marker for Acute Severity Transitions in Chronic Diseases
AU - Olde Rikkert, Marcel G.M.
AU - Dakos, Vasilis
AU - Buchman, Timothy G.
AU - Boer, Rob De
AU - Glass, Leon
AU - Cramer, Angelique O.J.
AU - Levin, Simon
AU - Van Nes, Egbert
AU - Sugihara, George
AU - Ferrari, Michel D.
AU - Tolner, Else A.
AU - Van De Leemput, Ingrid
AU - Lagro, Joep
AU - Melis, Rene
AU - Scheffer, Marten
N1 - Publisher Copyright:
© 2016 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.
PY - 2016/1/1
Y1 - 2016/1/1
N2 - 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.
AB - 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.
KW - Critical slowing down
KW - nonlinear dynamics
KW - recovery of function
KW - resilience
UR - http://www.scopus.com/inward/record.url?scp=84959231360&partnerID=8YFLogxK
U2 - 10.1097/CCM.0000000000001564
DO - 10.1097/CCM.0000000000001564
M3 - Article
C2 - 26765499
AN - SCOPUS:84959231360
SN - 0090-3493
VL - 44
SP - 601
EP - 606
JO - Critical Care Medicine
JF - Critical Care Medicine
IS - 3
ER -