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

Tao Bai,Jun Song,Feierkaiti Yushanjiang,Dan Zhou,Dongke Wang,Xinghuang Liu,Dongmei Zhang,Xiaohua Hou,Jianchu Zhang,Yanling Ma

doi:10.3389/fphys.2021.805925

Abstract

Previous studies suggest that autonomic dysfunction is associated with disease severity in acute phase in patients with coronavirus disease 2019 (COVID-19). However, the association between autonomic dysfunction and pulmonary sequelae in patients with COVID-19 is unknown. We conducted a prospective study to investigate the association between autonomic dysfunction and pulmonary sequelae in patients with COVID-19 discharged for 6 months. We included 40 eligible participants and collected the following indicators: heart rate variability (HRV), pulmonary function tests (PFTs), lung X-ray computed tomography (CT), routine blood parameters, liver function parameters, and lymphocyte subsets. We found that at 6 months post-discharge, HRV still had a tight correlation with pulmonary fibrosis. There was a significant difference in HRV between patients with and without diffusion dysfunction, but HRV did not differ between patients with or without ventilatory dysfunction. Diffusion dysfunction and pulmonary fibrosis were tightly associated, and HRV index changes in patients with diffusion dysfunction had the same trend as that of patients with pulmonary fibrosis. They had a lower standard deviation of NN intervals (SDNN), the standard deviation of the average NN intervals (SDANN), and the triangular index, but a higher ratio between LF and HF power (LF/HF). In addition, WBC, neutrophils, and CD4/CD8 were correlated with pulmonary fibrosis and HRV. We concluded that autonomic dysfunction is closely associated with pulmonary fibrosis and diffusion dysfunction, and immune mechanisms may potentially contribute to this process.

Highlights

According to the Coronavirus Resource Center at Johns Hopkins University, the global pandemic caused by coronavirus disease 2019 (COVID-19) has affected more than 230 million people
14 (35%) of the 40 participants were classified as mild patients and 26 (65%) as severe patients
We support that the long-term lung injury in patients with COVID-19 was dominated by diffusion dysfunction and that the structural sequelae were reflected in fibrosis

Summary

Introduction

According to the Coronavirus Resource Center at Johns Hopkins University, the global pandemic caused by coronavirus disease 2019 (COVID-19) has affected more than 230 million people. There have been more than 4.4 million deaths, and 180 million people have recovered (Lewis et al, 2021; Safont et al, 2021) With such a significant recovered population, we must be concerned about the long-term lung damage caused by COVID-19 infection (Zhao et al, 2020). 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). We do not know whether there are associations between long-term autonomic disorders and pulmonary sequelae (Wang et al, 2020; Dani et al, 2021; McDonald, 2021)

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