Key result
Sympathetic overactivation is proposed as a potential undervalued mechanism creating a vicious circle between COVID-19 and associated comorbidities.
Why the study?
The potential role of sympathetic nervous system activation had not yet been considered in the pathophysiology of COVID-19 and its link with comorbidities.
Sympathetic overactivation is proposed as a potential pathophysiological link explaining the higher morbidity and mortality in COVID-19 patients with underlying comorbidities.
Sympathetic overdrive may worsen COVID-19 outcomes in comorbid patients; hypothesis-generating and requires prospective validation before clinical consideration.
In coronavirus disease 2019 (COVID-19), higher morbidity and mortality are associated with age, male gender, and comorbidities, such as chronic lung diseases, cardiovascular pathologies, hypertension, kidney diseases, diabetes mellitus, and obesity. All of the above conditions are characterized by increased sympathetic discharge, which may exert significant detrimental effects on COVID-19 patients, through actions on the lungs, heart, blood vessels, kidneys, metabolism, and/or immune system. Furthermore, COVID-19 may also increase sympathetic discharge, through changes in blood gases (chronic intermittent hypoxia, hyperpnea), angiotensin-converting enzyme (ACE)1/ACE2 imbalance, immune/inflammatory factors, or emotional distress. Nevertheless, the potential role of the sympathetic nervous system has not yet been considered in the pathophysiology of COVID-19. In our opinion, sympathetic overactivation could represent a so-far undervalued mechanism for a vicious circle between COVID-19 and comorbidities.
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Porzionato et al. (2020) conducted a review in COVID-19. Sympathetic activation was evaluated. Sympathetic overactivation is proposed as a potential undervalued mechanism creating a vicious circle between COVID-19 and associated comorbidities.
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