Heart-rate-variability (HRV), predicts outcomes in COVID-19
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 deter...
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| creator | Mol, Maartje B. A Strous, Maud T. A van Osch, Frits H. M Vogelaar, F. Jeroen Barten, Dennis G Farchi, Moshe Foudraine, Norbert A Gidron, Yori |
| description | 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 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. |
| doi_str_mv | 10.1371/journal.pone.0258841 |
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| fullrecord | <record><control><sourceid>gale_plos_</sourceid><recordid>TN_cdi_plos_journals_2587705681</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A680517131</galeid><doaj_id>oai_doaj_org_article_30ed7b1550eb4a15ab2ebb3937a54868</doaj_id><sourcerecordid>A680517131</sourcerecordid><originalsourceid>FETCH-LOGICAL-c636t-d3cddbea93f943611fc3e90ab5f19f2124cd1c128475530e6d17f17ce2ae6d573</originalsourceid><addsrcrecordid>eNptkl2L1DAUhoso7rr6DwQL3qxgx5ym-SiCsIwfM7CwILq3IU1OxwxtMybtwv57U6eKI0suEk6e857zwptlL4GsgAp4t_dTGHS3OvgBV6RkUlbwKDuHmpYFLwl9_M_7LHsW454QRiXnT7MzWgkgUIrz7P0GdRiLoEcs7nRwunGdG-_zy83X2zdv80NA68wYcz-NxvcYczfk65vb7ccC6ufZk1Z3EV8s90X2_fOnb-tNcX3zZbu-ui4Mp3wsLDXWNqhr2tYV5QCtoVgT3bAW6raEsjIWDJSyEoxRgtyCaEEYLHV6M0EvsldH3UPno1p8R5UsC0EYl5CI7ZGwXu_VIbheh3vltVO_Cz7sVHLpTIcqDbCiAcYINpUGppsSm4bWVGhWSS6T1odl2tT0aA0OY9Ddiejpz-B-qJ2_U3LeXtAkcLkIBP9zwjiq3kWDXacH9NO8d02IhJqXCX39H_qwu4Xa6WTADa1Pc80sqq64JAwE0JlaPUClY7F3JoWkdal-0lAdG0zwMQZs_3oEouaI_VlGzRFTS8ToLyqzwWU</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2587705681</pqid></control><display><type>article</type><title>Heart-rate-variability (HRV), predicts outcomes in COVID-19</title><source>DOAJ Directory of Open Access Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>PubMed Central</source><source>Free Full-Text Journals in Chemistry</source><source>Public Library of Science (PLoS)</source><creator>Mol, Maartje B. A ; Strous, Maud T. A ; van Osch, Frits H. M ; Vogelaar, F. Jeroen ; Barten, Dennis G ; Farchi, Moshe ; Foudraine, Norbert A ; Gidron, Yori</creator><contributor>Tolkacheva, Elena G.</contributor><creatorcontrib>Mol, Maartje B. A ; Strous, Maud T. A ; van Osch, Frits H. M ; Vogelaar, F. Jeroen ; Barten, Dennis G ; Farchi, Moshe ; Foudraine, Norbert A ; Gidron, Yori ; Tolkacheva, Elena G.</creatorcontrib><description>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 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.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0258841</identifier><identifier>PMID: 34710127</identifier><language>eng</language><publisher>San Francisco: Public Library of Science</publisher><subject>Analysis ; Biology and Life Sciences ; Bradycardia ; Coronaviruses ; COVID-19 ; Disease ; EKG ; Evaluation ; Heart beat ; Heart rate ; Hospitals ; Hypertension ; Immune response ; Immune system ; Immunomodulators ; Infections ; Inflammation ; Intensive care ; Measurement ; Medical prognosis ; Medicine and Health Sciences ; Mortality ; Pacemakers ; Patients ; Population ; Research and Analysis Methods ; Severe acute respiratory syndrome coronavirus 2 ; Supervision ; Surgery ; Survival ; Tachycardia ; Vagus nerve ; Ventricle ; Viral diseases ; Viral infections</subject><ispartof>PloS one, 2021-10, Vol.16 (10), p.e0258841-e0258841</ispartof><rights>COPYRIGHT 2021 Public Library of Science</rights><rights>2021 Mol et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2021 Mol et al 2021 Mol et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c636t-d3cddbea93f943611fc3e90ab5f19f2124cd1c128475530e6d17f17ce2ae6d573</citedby><cites>FETCH-LOGICAL-c636t-d3cddbea93f943611fc3e90ab5f19f2124cd1c128475530e6d17f17ce2ae6d573</cites><orcidid>0000-0001-7116-4465 ; 0000-0002-7185-9491 ; 0000-0003-3041-4872</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8553073/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8553073/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79343,79344</link.rule.ids></links><search><contributor>Tolkacheva, Elena G.</contributor><creatorcontrib>Mol, Maartje B. A</creatorcontrib><creatorcontrib>Strous, Maud T. A</creatorcontrib><creatorcontrib>van Osch, Frits H. M</creatorcontrib><creatorcontrib>Vogelaar, F. Jeroen</creatorcontrib><creatorcontrib>Barten, Dennis G</creatorcontrib><creatorcontrib>Farchi, Moshe</creatorcontrib><creatorcontrib>Foudraine, Norbert A</creatorcontrib><creatorcontrib>Gidron, Yori</creatorcontrib><title>Heart-rate-variability (HRV), predicts outcomes in COVID-19</title><title>PloS one</title><description>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 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. 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A</au><au>Strous, Maud T. A</au><au>van Osch, Frits H. M</au><au>Vogelaar, F. Jeroen</au><au>Barten, Dennis G</au><au>Farchi, Moshe</au><au>Foudraine, Norbert A</au><au>Gidron, Yori</au><au>Tolkacheva, Elena G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Heart-rate-variability (HRV), predicts outcomes in COVID-19</atitle><jtitle>PloS one</jtitle><date>2021-10-28</date><risdate>2021</risdate><volume>16</volume><issue>10</issue><spage>e0258841</spage><epage>e0258841</epage><pages>e0258841-e0258841</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><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 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.</abstract><cop>San Francisco</cop><pub>Public Library of Science</pub><pmid>34710127</pmid><doi>10.1371/journal.pone.0258841</doi><orcidid>https://orcid.org/0000-0001-7116-4465</orcidid><orcidid>https://orcid.org/0000-0002-7185-9491</orcidid><orcidid>https://orcid.org/0000-0003-3041-4872</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Analysis Biology and Life Sciences Bradycardia Coronaviruses COVID-19 Disease EKG Evaluation Heart beat Heart rate Hospitals Hypertension Immune response Immune system Immunomodulators Infections Inflammation Intensive care Measurement Medical prognosis Medicine and Health Sciences Mortality Pacemakers Patients Population Research and Analysis Methods Severe acute respiratory syndrome coronavirus 2 Supervision Surgery Survival Tachycardia Vagus nerve Ventricle Viral diseases Viral infections |
| title | Heart-rate-variability (HRV), predicts outcomes in COVID-19 |
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