AUTHOR=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 

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

JOURNAL=Frontiers in Physiology

VOLUME=12

YEAR=2021

URL=https://www.frontiersin.org/journals/physiology/articles/10.3389/fphys.2021.630038

DOI=10.3389/fphys.2021.630038

ISSN=1664-042X

ABSTRACT=<sec><title>Background</title><p>Previous studies suggest that coronavirus disease 2019 (COVID-19) is a systemic infection involving multiple systems, and may cause autonomic dysfunction.</p></sec><sec><title>Objective</title><p>To assess autonomic function and relate the findings to the severity and outcomes in COVID-19 patients.</p></sec><sec><title>Methods</title><p>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), <sc>D</sc>-dimer, and lymphocytes and subsets counts were analysed at two time points: nucleic-acid test positive and negative. Psychological symptoms were assessed after discharge.</p></sec><sec><title>Results</title><p>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) (<italic>P</italic> &lt; 0.001), standard deviation of the averages of NN intervals (SDANN) (<italic>P</italic> &lt; 0.001), and a higher ratio of low- to high-frequency power (LF/HF) (<italic>P</italic> = 0.016). Linear correlations were shown among SDNN, SDANN, LF/HF, and laboratory indices (<italic>P</italic> &lt; 0.05). Immune function, <sc>D</sc>-dimer, and NT-proBNP showed a consistent trend with HRV in severe patients (<italic>P</italic> &lt; 0.05), and severe patients without improved HRV parameters needed a longer time to clear the virus and recover (<italic>P</italic> &lt; 0.05).</p></sec><sec><title>Conclusion</title><p>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.</p></sec>