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

• Published in: Frontiers in physiology Vol. 12; p. 630038
• Main Authors: Pan, Yuchen, Yu, Zhiyao, Yuan, Yuan, Han, Jiapeng, Wang, Zhuo, Chen, Hui, Wang, Songyun, Wang, Zhen, Hu, Huihui, Zhou, Liping, Lai, Yanqiu, Zhou, Zhen, Wang, Yuhong, Meng, Guannan, Yu, Lilei, Jiang, Hong
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 19.05.2021
• Subjects: autonomic nervous system; clinical outcomes; COVID-19; d-dimer; heart rate variability; lymphocyte; Physiology; COVID-19; clinical outcomes; autonomic nervous system; heart rate variability; d-dimer; N-terminal Pro-B-type natriuretic peptide; lymphocyte
• ISSN: 1664-042X; 1664-042X
• DOI: 10.3389/fphys.2021.630038

Previous studies suggest that coronavirus disease 2019 (COVID-19) is a systemic infection involving multiple systems, and may cause autonomic dysfunction. To assess autonomic function and relate the findings to the severity and outcomes in COVID-19 patients. 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. 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) ( < 0.001), standard deviation of the averages of NN intervals (SDANN) ( < 0.001), and a higher ratio of low- to high-frequency power (LF/HF) ( = 0.016). Linear correlations were shown among SDNN, SDANN, LF/HF, and laboratory indices ( < 0.05). Immune function, D-dimer, and NT-proBNP showed a consistent trend with HRV in severe patients ( < 0.05), and severe patients without improved HRV parameters needed a longer time to clear the virus and recover ( < 0.05). 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.