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

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          Abstract

          Background

          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.

          Methods

          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.

          Results

          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).

          Conclusion

          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.

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          Dysregulation of immune response in patients with COVID-19 in Wuhan, China

          Chuan Qin, Luoqi Zhou, Ziwei Hu … (2020)
          Abstract Background In December 2019, coronavirus disease 2019 (COVID-19) emerged in Wuhan and rapidly spread throughout China. Methods Demographic and clinical data of all confirmed cases with COVID-19 on admission at Tongji Hospital from January 10 to February 12, 2020, were collected and analyzed. The data of laboratory examinations, including peripheral lymphocyte subsets, were analyzed and compared between severe and non-severe patients. Results Of the 452 patients with COVID-19 recruited, 286 were diagnosed as severe infection. The median age was 58 years and 235 were male. The most common symptoms were fever, shortness of breath, expectoration, fatigue, dry cough and myalgia. Severe cases tend to have lower lymphocytes counts, higher leukocytes counts and neutrophil-lymphocyte-ratio (NLR), as well as lower percentages of monocytes, eosinophils, and basophils. Most of severe cases demonstrated elevated levels of infection-related biomarkers and inflammatory cytokines. The number of T cells significantly decreased, and more hampered in severe cases. Both helper T cells and suppressor T cells in patients with COVID-19 were below normal levels, and lower level of helper T cells in severe group. The percentage of naïve helper T cells increased and memory helper T cells decreased in severe cases. Patients with COVID-19 also have lower level of regulatory T cells, and more obviously damaged in severe cases. Conclusions The novel coronavirus might mainly act on lymphocytes, especially T lymphocytes. Surveillance of NLR and lymphocyte subsets is helpful in the early screening of critical illness, diagnosis and treatment of COVID-19.
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            An Overview of Heart Rate Variability Metrics and Norms

            Fred Shaffer, J. Ginsberg (2017)
            Healthy biological systems exhibit complex patterns of variability that can be described by mathematical chaos. Heart rate variability (HRV) consists of changes in the time intervals between consecutive heartbeats called interbeat intervals (IBIs). A healthy heart is not a metronome. The oscillations of a healthy heart are complex and constantly changing, which allow the cardiovascular system to rapidly adjust to sudden physical and psychological challenges to homeostasis. This article briefly reviews current perspectives on the mechanisms that generate 24 h, short-term (~5 min), and ultra-short-term (<5 min) HRV, the importance of HRV, and its implications for health and performance. The authors provide an overview of widely-used HRV time-domain, frequency-domain, and non-linear metrics. Time-domain indices quantify the amount of HRV observed during monitoring periods that may range from ~2 min to 24 h. Frequency-domain values calculate the absolute or relative amount of signal energy within component bands. Non-linear measurements quantify the unpredictability and complexity of a series of IBIs. The authors survey published normative values for clinical, healthy, and optimal performance populations. They stress the importance of measurement context, including recording period length, subject age, and sex, on baseline HRV values. They caution that 24 h, short-term, and ultra-short-term normative values are not interchangeable. They encourage professionals to supplement published norms with findings from their own specialized populations. Finally, the authors provide an overview of HRV assessment strategies for clinical and optimal performance interventions.
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              Laboratory Diagnosis of COVID-19: Current Issues and Challenges

              Yi-Wei Tang, Jonathan E. Schmitz, David Persing … (2020)
              The COVID-19 outbreak has had a major impact on clinical microbiology laboratories in the past several months. This commentary covers current issues and challenges for the laboratory diagnosis of infections caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In the preanalytical stage, collecting the proper respiratory tract specimen at the right time from the right anatomic site is essential for a prompt and accurate molecular diagnosis of COVID-19. Appropriate measures are required to keep laboratory staff safe while producing reliable test results.
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                Author and article information

                Contributors
                Maartje B. A. Mol: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: VisualizationRole: Writing – original draft
                Maud T. A. Strous:
                ORCID: https://orcid.org/0000-0001-7116-4465
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: VisualizationRole: Writing – original draft
                Frits H. M. van Osch: Role: Data curationRole: Formal analysisRole: MethodologyRole: ResourcesRole: Writing – review & editing
                F. Jeroen Vogelaar: Role: ConceptualizationRole: Project administrationRole: SupervisionRole: Writing – review & editing
                Dennis G. Barten:
                ORCID: https://orcid.org/0000-0002-7185-9491
                Role: Data curationRole: ResourcesRole: ValidationRole: Writing – review & editing
                Moshe Farchi:
                ORCID: https://orcid.org/0000-0003-3041-4872
                Role: ConceptualizationRole: Writing – review & editing
                Norbert A. Foudraine: Role: ConceptualizationRole: Data curationRole: ResourcesRole: SupervisionRole: ValidationRole: Writing – review & editing
                Yori Gidron: Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – original draft
                Elena G. Tolkacheva: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS One
                Journal ID (publisher-id): plos
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 28 October 2021
                Publication date Collection: 2021
                Publication date PMC-release: 28 October 2021
                Volume: 16
                Issue: 10
                Electronic Location Identifier: e0258841
                Affiliations
                [1 ] Department of Surgery, VieCuri Medical Centre Venlo, Venlo, The Netherlands
                [2 ] Department of Intensive Care, VieCuri Medical Centre Venlo, Venlo, The Netherlands
                [3 ] Department of Epidemiology, VieCuri Medical Centre Venlo, Venlo, The Netherlands
                [4 ] Department of Emergency Medicine, VieCuri Medical Centre Venlo, Venlo, The Netherlands
                [5 ] School of Social Work, Tel-Hai College, Qiryat Shemona, Israël
                [6 ] Faculty of Welfare and Health Sciences, University of Haifa, Haifa, Israel
                University of Minnesota, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0001-7116-4465
                https://orcid.org/0000-0002-7185-9491
                https://orcid.org/0000-0003-3041-4872
                Article
                Publisher ID: PONE-D-21-10657
                DOI: 10.1371/journal.pone.0258841
                PMC ID: 8553073
                PubMed ID: 34710127
                SO-VID: 152ecb0d-8a63-447e-931c-a49f5927b815
                Copyright © © 2021 Mol et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 31 March 2021
                Date accepted : 6 October 2021
                Page count
                Figures: 1, Tables: 5, Pages: 12
                Funding
                The author(s) received no specific funding for this work.
                Categories
                Subject: Research Article
                Subject: Medicine and Health Sciences
                Subject: Medical Conditions
                Subject: Infectious Diseases
                Subject: Viral Diseases
                Subject: Covid 19
                Subject: Medicine and Health Sciences
                Subject: Health Care
                Subject: Health Care Facilities
                Subject: Hospitals
                Subject: Intensive Care Units
                Subject: Biology and Life Sciences
                Subject: Immunology
                Subject: Immune Response
                Subject: Inflammation
                Subject: Medicine and Health Sciences
                Subject: Immunology
                Subject: Immune Response
                Subject: Inflammation
                Subject: Medicine and Health Sciences
                Subject: Clinical Medicine
                Subject: Signs and Symptoms
                Subject: Inflammation
                Subject: Research and Analysis Methods
                Subject: Bioassays and Physiological Analysis
                Subject: Electrophysiological Techniques
                Subject: Cardiac Electrophysiology
                Subject: Electrocardiography
                Subject: Medicine and Health Sciences
                Subject: Medical Conditions
                Subject: Cardiovascular Diseases
                Subject: Medicine and Health Sciences
                Subject: Cardiology
                Subject: Cardiovascular Medicine
                Subject: Cardiovascular Diseases
                Subject: Biology and Life Sciences
                Subject: Immunology
                Subject: Immune Response
                Subject: Medicine and Health Sciences
                Subject: Immunology
                Subject: Immune Response
                Subject: Medicine and Health Sciences
                Subject: Diagnostic Medicine
                Subject: Prognosis
                Subject: Medicine and Health Sciences
                Subject: Medical Conditions
                Subject: Infectious Diseases
                Subject: Respiratory Infections
                Subject: Medicine and Health Sciences
                Subject: Medical Conditions
                Subject: Respiratory Disorders
                Subject: Respiratory Infections
                Subject: Medicine and Health Sciences
                Subject: Pulmonology
                Subject: Respiratory Disorders
                Subject: Respiratory Infections
                Custom metadata
                Data Availability Data cannot be shared publicly because of ethical concerns. Patients were included on a no objection base to conduct retrospective data studies and publish findings, but were not asked for permission to publish full encrypted data. Data are available from the VieCuri Institutional Data Access (contact via wetenschapsbureau@ 123456viecuri.nl ) for researchers who meet the criteria for access to confidential data.
                Outbreaks COVID-19

                ScienceOpen disciplines: Uncategorized
                Data availability:
                ScienceOpen disciplines: Uncategorized

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