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

Abstract

BackgroundPrevious studies suggest that coronavirus disease 2019 (COVID-19) is a systemic infection involving multiple systems, and may cause autonomic dysfunction.ObjectiveTo assess autonomic function and relate the findings to the severity and outcomes in COVID-19 patients.MethodsWe 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.ResultsAll 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).ConclusionHRV 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.

Auricular Neuromodulation for Mass Vagus Nerve Stimulation: Insights From SOS COVID-19 a Multicentric, Randomized, Controlled, Double-Blind French Pilot Study

“…Such monitoring is not at all cumbersome as the patients are continuously monitored. In fact, in a recent study, a Holter monitor was used to record, collect, and analyze the dynamic ECG data over 24 consecutive hours for all 34 patients (Pan et al, 2021 ). Nevertheless, most non-ICU patients were regularly, but only occasionally, monitored, and the medical-grade accuracy of HRV by the smartphone apps was not available at that time in our hospitals.…”

“…Nevertheless, most non-ICU patients were regularly, but only occasionally, monitored, and the medical-grade accuracy of HRV by the smartphone apps was not available at that time in our hospitals. However, we believed that the HRV parameter constitutes an optimal primary endpoint for the upcoming trials (Pan et al, 2021 ).…”

“…In the chaotic situation of the first COVID-19 wave, we wanted to select the most convenient primary endpoint, which is easy to acquire from medical files, i.e., the clinical improvement on a pragmatic validated scale (Cao et al, 2020). Nevertheless, contrary to the known effect of fast pain relief, taVNS through SPN might require a relatively longer period (i.e., more than 14 days) to elicit a significant clinical improvement in severe SARS-CoV-2 infection (as suggested by Pan et al, 2021). In fact, iVNS is known to be a slow-acting therapy as reported in epilepsy (Panebianco et al, 2015) and inflammatory bowel diseases (Sinniger et al, 2020).…”

“…Several epidemiological studies have shown that reduced HRV is a risk factor for all-cause mortality and morbidity (Liao et al, 2002 ), not only in cardiovascular diseases (Fang et al, 2020 ), metabolic diseases (Pavlov, 2021 ), and neurodegenerative diseases (Rangon et al, 2020 ), but also in acute respiratory distress syndrome (ARDS) (Chen et al, 2018 ), sepsis (De Castilho et al, 2018 ; Barnaby et al, 2019 ), and the severe infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Hasty et al, 2020 ; Leitzke et al, 2020 ; Aragon-Benedi et al, 2021 ; Pan et al, 2021 ).…”

Alternation of the Autonomic Nervous System Is Associated With Pulmonary Sequelae in Patients With COVID-19 After Six Months of Discharge

“…In addition, even under the influence of factors, such as hypoxia and stress, HRV was still associated with the severity of patients in the acute phase (Natarajan et al, 2020;Luong et al, 2021). Severe patients without improved HRV needed longer to clear the virus and recover, indicating that HRV can be used as a non-invasive predictor for short-term clinical outcomes (Pan et al, 2021). Meanwhile, some studies suggest that the immune system is associated with long-term autonomic disorders and pulmonary sequelae in patients with COVID-19 (Kenney and Ganta, 2014;Hasty et al, 2021;Wang et al, 2020;Wu et al, 2021).…”