Department of Surgery, VieCuri Medical Centre Venlo, Venlo, The Netherlands.
Department of Intensive Care, VieCuri Medical Centre Venlo, Venlo, The Netherlands.
PLoS One. 2021 Oct 28;16(10):e0258841. doi: 10.1371/journal.pone.0258841. eCollection 2021.
Patients 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.
A 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.
HRV 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).
Higher 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.
COVID-19 患者表现出多种临床表现，从轻症或无症状疾病到重症疾病乃至死亡。尽管先前的研究已经阐明了 COVID-19 的这些方面以及其他几个方面，但 COVID-19 持续存在的挑战之一是确定哪些患者有感染 COVID-19 的不良后果的风险。据推测，这是由于免疫反应抑制不足所致，而迷走神经是炎症的重要神经免疫调节剂。迷走神经活动可以通过心率变异性（HRV）进行非侵入性索引。因此，我们旨在评估 HRV（作为迷走神经活动的替代标志物）在预测 COVID-19 住院患者死亡率和 ICU 转诊方面的预后价值。
这是一项回顾性队列研究，纳入了 2020 年 3 月至 2020 年 5 月期间连续诊断和住院的所有 COVID-19 患者（n = 271），这些患者无心律失常（包括房性和室性期前收缩）、起搏器病史，也没有当前心动过缓（心率<50 bpm）或心动过速（心率>110 bpm）。HRV 基于入院时记录的 10s 心电图。检查了 3 周的生存率和 ICU 转诊情况。
HRV 以正常心跳间隔标准差（SDNN）表示，可预测生存率（HR = 0.53，95%CI：0.31-0.92）。这种保护作用仅在 70 岁及以上的患者中观察到，而在年轻患者中则没有。入院后第一周 HRV 低于中位数也预测 ICU 转诊（HR = 0.51，95%CI：0.29-0.90，P = 0.021）。
较高的 HRV 预示着更高的生存率，特别是在 70 岁及以上的 COVID-19 患者中，独立于主要预后因素。低 HRV 预示着住院后第一周 ICU 指征和入院。
