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

Marcel G M Olde Rikkert, Vasilis Dakos, Timothy G Buchman, Rob de Boer, Leon Glass, A.O.J. Cramer, Simon Levin, Egbert van Nes, George Sugihara, Michel D Ferrari, Else A Tolner, Ingrid van de Leemput, Joep Lagro, René Melis, Marten Scheffer

Research output: Contribution to journalArticleScientificpeer-review

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.

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.

Original languageEnglish
Pages (from-to)601-606
JournalCritical Care Medicine
Volume44
Issue number3
DOIs
Publication statusPublished - 2016
Externally publishedYes

Fingerprint

Medicine
Disease Management
Ecology
Depression
Incidence

Keywords

  • Chronic Disease
  • Critical Care
  • Feedback
  • Humans
  • Models, Biological
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index
  • Journal Article
  • Research Support, Non-U.S. Gov't

Cite this

Olde Rikkert, Marcel G M ; Dakos, Vasilis ; Buchman, Timothy G ; Boer, Rob de ; Glass, Leon ; Cramer, A.O.J. ; Levin, Simon ; van Nes, Egbert ; Sugihara, George ; Ferrari, Michel D ; Tolner, Else A ; van de Leemput, Ingrid ; Lagro, Joep ; Melis, René ; Scheffer, Marten. / Slowing down of recovery as generic risk marker for acute severity transitions in chronic diseases. In: Critical Care Medicine. 2016 ; Vol. 44, No. 3. pp. 601-606.
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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.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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Olde Rikkert, MGM, Dakos, V, Buchman, TG, Boer, RD, Glass, L, Cramer, AOJ, Levin, S, van Nes, E, Sugihara, G, Ferrari, MD, Tolner, EA, van de Leemput, I, Lagro, J, Melis, R & Scheffer, M 2016, 'Slowing down of recovery as generic risk marker for acute severity transitions in chronic diseases', Critical Care Medicine, vol. 44, no. 3, pp. 601-606. https://doi.org/10.1097/CCM.0000000000001564

Slowing down of recovery as generic risk marker for acute severity transitions in chronic diseases. / Olde Rikkert, Marcel G M; Dakos, Vasilis; Buchman, Timothy G; Boer, Rob de; Glass, Leon; Cramer, A.O.J.; Levin, Simon; van Nes, Egbert; Sugihara, George; Ferrari, Michel D; Tolner, Else A; van de Leemput, Ingrid; Lagro, Joep; Melis, René; Scheffer, Marten.

In: Critical Care Medicine, Vol. 44, No. 3, 2016, p. 601-606.

Research output: Contribution to journalArticleScientificpeer-review

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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, A.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, René

AU - Scheffer, Marten

PY - 2016

Y1 - 2016

N2 - 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.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 - 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.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 - Chronic Disease

KW - Critical Care

KW - Feedback

KW - Humans

KW - Models, Biological

KW - Risk Assessment

KW - Risk Factors

KW - Severity of Illness Index

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

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DO - 10.1097/CCM.0000000000001564

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