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

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

Front Physiol. 2021 May 19:12:630038. doi: 10.3389/fphys.2021.630038. eCollection 2021.

Authors

Yuchen Pan^{1

2

3

4}, Zhiyao Yu^{1

2

3

4}, Yuan Yuan^{1

2

3

4}, Jiapeng Han^{1

2

3

4}, Zhuo Wang^{1

2

3

4}, Hui Chen^{1

2

3

4}, Songyun Wang^{1

2

3

4}, Zhen Wang^{1

2

3

4}, Huihui Hu^{1

2

3

4}, Liping Zhou^{1

2

3

4}, Yanqiu Lai^{1

2

3

4}, Zhen Zhou^{1

2

3

4}, Yuhong Wang^{1

2

3

4}, Guannan Meng^{1

2

3

4}, Lilei Yu^{1

2

3

4}, Hong Jiang^{1

2

3

4}

Affiliations

¹ Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.
² Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, China.
³ Cardiovascular Research Institute, Wuhan University, Wuhan, China.
⁴ Hubei Key Laboratory of Cardiology, Wuhan, China.

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.

Keywords: COVID-19; N-terminal Pro-B-type natriuretic peptide; autonomic nervous system; clinical outcomes; d-dimer; heart rate variability; lymphocyte.