Heart-rate-variability (HRV), predicts outcomes in COVID-19.

Maartje B A Mol,Dennis G Barten,Frits H M Van Osch,F Jeroen Vogelaar,Norbert A Foudraine,Maud T A Strous,Moshe Farchi,Yori Gidron,Elena G Tolkacheva

doi:10.1371/journal.pone.0258841

Maartje B A Mol, Dennis G Barten + Show 7 more

Open Access

https://doi.org/10.1371/journal.pone.0258841

Copy DOI

Abstract

BackgroundPatients with COVID-19 present with a variety of clinical manifestations, ranging from mild or asymptomatic disease to severe illness and death. Whilst previous studies have clarified these and several other aspects of COVID-19, one of the ongoing challenges regarding COVID-19 is to determine which patients are at risk of adverse outcomes of COVID-19 infection. It is hypothesized that this is the result of insufficient inhibition of the immune response, with the vagus nerve being an important neuro-immuno-modulator of inflammation. Vagus nerve activity can be non-invasively indexed by heart-rate-variability (HRV). Therefore, we aimed to assess the prognostic value of HRV, as a surrogate marker for vagus nerve activity, in predicting mortality and intensive care unit (ICU) referral, in patients hospitalized with COVID-19.MethodsA retrospective cohort study including all consecutive patients (n = 271) diagnosed and hospitalized with COVID-19 between March 2020 and May 2020, without a history of cardiac arrhythmias (including atrial and ventricular premature contractions), pacemaker, or current bradycardia (heart rate <50 bpm) or tachycardia (heart rate >110 bpm). HRV was based on one 10s ECG recorded at admission. 3-week survival and ICU referral were examined.ResultsHRV indexed as standard deviation of normal to normal heartbeat intervals (SDNN) predicted survival (H.R. = 0.53 95%CI: 0.31–0.92). This protective role was observed only in patients aged 70 years and older, not in younger patients. HRV below median value also predicted ICU referral within the first week of hospitalization (H.R = 0.51, 95%CI: 0.29–0.90, P = 0.021).ConclusionHigher HRV predicts greater chances of survival, especially in patients aged 70 years and older with COVID-19, independent of major prognostic factors. Low HRV predicts ICU indication and admission in the first week after hospitalization.

Highlights

The severe acute respiratory syndrome due to coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), has been declared a pandemic by the World Health Organization [1]
Whilst previous studies have clarified these and several other aspects of COVID-19, one of the ongoing challenges regarding COVID-19 is to determine which patients are at risk of adverse outcomes of COVID-19 infection
We aimed to assess the prognostic value of HRV, as a surrogate marker for vagus nerve activity, in predicting mortality and intensive care unit (ICU) referral, in patients hospitalized with COVID-19

Summary

Introduction

The severe acute respiratory syndrome due to coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), has been declared a pandemic by the World Health Organization [1]. A descending efferent vagal-to-sympathetic neural conversion occurs at the celiac ganglion and reaches the spleen, where a sub-class of T-cells secrete acetylcholine and inhibit splenic macrophages from producing inflammatory cytokines [9,10,11]. When this anti-inflammatory regulatory response works properly, it limits the dissemination of viral infections and is vital for the control and resolution of the infection and its inflammatory consequences. Patients with COVID-19 present with a variety of clinical manifestations, ranging from mild or asymptomatic disease to severe illness and death. We aimed to assess the prognostic value of HRV, as a surrogate marker for vagus nerve activity, in predicting mortality and intensive care unit (ICU) referral, in patients hospitalized with COVID-19

Objectives

Results

Conclusion