Alteration of Autonomic Nervous System Is Associated With Severity and Outcomes in Patients With COVID-19

Yuchen Pan; Zhiyao Yu; Yuan Yuan; Jiapeng Han; Zhuo Wang; Hui Chen; Songyun Wang; Zhen Wang; Huihui Hu; Liping Zhou; Yanqiu Lai; Zhen Zhou; Yuhong Wang; Guannan Meng; Lilei Yu; Hong Jiang

doi:10.3389/fphys.2021.630038

May 19, 2021Frontiers in PhysiologyOpen Access

Alteration of Autonomic Nervous System Is Associated With Severity and Outcomes in Patients With COVID-19

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Why the study?

COVID-19 is a systemic infection that may cause autonomic dysfunction, prompting assessment of autonomic function and its relationship to disease severity and outcomes.

Is heart rate variability associated with disease severity and clinical outcomes in patients with COVID-19?

Structured PICO

Is heart rate variability associated with disease severity and clinical outcomes in patients with COVID-19?

P

Population

34 consecutive patients with COVID-19 admitted to Renmin Hospital of Wuhan University (13 mild, 21 severe)

O

Outcome

Association of heart rate variability (HRV) parameters with COVID-19 severity and clinical outcomes (time to clear virus and recover)surrogate

Heart rate variability parameters are significantly altered in severe COVID-19 and may serve as non-invasive predictors for clinical recovery and viral clearance.

Implication

Autonomic assessment may flag higher-risk COVID-19 cases; hypothesis-generating for outcomes and needs prospective validation.

Abstract

Background Previous studies suggest that coronavirus disease 2019 (COVID-19) is a systemic infection involving multiple systems, and may cause autonomic dysfunction. Objective To assess autonomic function and relate the findings to the severity and outcomes in COVID-19 patients. Methods We included consecutive patients with COVID-19 admitted to the 21st COVID-19 Department of the east campus of Renmin Hospital of Wuhan University from February 6 to March 7, 2020. Clinical data were collected. Heart rate variability (HRV), N-terminal pro-B-type natriuretic peptide (NT-proBNP), D-dimer, and lymphocytes and subsets counts were analysed at two time points: nucleic-acid test positive and negative. Psychological symptoms were assessed after discharge. Results All patients were divided into a mild group (13) and a severe group (21). The latter was further divided into two categories according to the trend of HRV. Severe patients had a significantly lower standard deviation of the RR intervals (SDNN) (P < 0.001), standard deviation of the averages of NN intervals (SDANN) (P < 0.001), and a higher ratio of low- to high-frequency power (LF/HF) (P = 0.016). Linear correlations were shown among SDNN, SDANN, LF/HF, and laboratory indices (P < 0.05). Immune function, D-dimer, and NT-proBNP showed a consistent trend with HRV in severe patients (P < 0.05), and severe patients without improved HRV parameters needed a longer time to clear the virus and recover (P < 0.05). Conclusion HRV was associated with the severity of COVID-19. The changing trend of HRV was related to the prognosis, indicating that HRV measurements can be used as a non-invasive predictor for clinical outcome.