Autonomic dysfunction in non-critically ill COVID-19 patients during the acute phase of disease: an observational, cross-sectional study

Abstract

Introduction Evidence is emerging about an extra-pulmonary involvement of SARS-CoV-2, including the nervous system. Autonomic dysfunction in patients recovering from acute coronavirus disease 2019 (COVID-19) has been recently described. Dysautonomic symptoms have been reported in the acute phase of the disease, but clear evidence is lacking, especially in the non-critical forms of the infection. Objective The aim of this study is to assess the prevalence of dysautonomia in acute, non-critically ill COVID-19 patients. Methods In this observational, cross-sectional study, we compared 38 non-critically ill patients with acute COVID-19 (COVID + group) to 38 healthy volunteers (COVID − group) in order to assess the prevalence of signs and symptoms of dysautonomia through the administration of the composite autonomic symptom score 31 (COMPASS-31) and an active standing test. Comparisons between groups were performed by means of both univariate and multivariate analyses. Results The prevalence of orthostatic hypotension was significantly higher in the COVID + group. Higher total scores of COMPASS-31 were observed in the COVID + group than controls. Significant differences between groups emerged in the secretomotor, orthostatic intolerance, and gastrointestinal COMPASS-31 domains. All these results maintained the statistical significance after the adjustment for concomitant drugs with a known effect on the autonomic nervous system assumed by the study participants, except for the differences in the gastrointestinal domain of COMPASS-31. Conclusion Our results suggest that an autonomic dysfunction could be an early manifestation of COVID-19, even in the contest of mild forms of the infection.

Autonomic Dysfunction during Acute SARS-CoV-2 Infection: A Systematic Review

“…Moreover, the occurrence of verified "autonomic syndromes" in patients with acute COVID-19, such as orthostatic hypotension [44], POTS, hyperhidrosis, pupil abnormalities, and small fiber neuropathy [39], further supports the hypothesis of an autonomic involvement during the acute phase of the disease. In a recent published study, we confirmed a higher prevalence of orthostatic hypotension in acute COVID-19 patients than in healthy controls [104].…”

Autonomic and neuropathic complaints of long-COVID objectified: an investigation from electrophysiological perspective

“…However, autonomic dysfunction is also common. It is demonstrated that dysautonomia plays an important role in the acute phase of COVID-19 patients even if non-critically ill [ 23 ]. A retrospective review of symptoms concerning para-/post-infectious autonomic dysfunction after COVID-19 revealed lightheadedness, orthostatic headache, syncope, hyperhidrosis, and burning pain [ 24 ].…”

Clinical presentation and management strategies of cardiovascular autonomic dysfunction following a COVID‐19 infection – A systematic review

“…Cytokines and other immunological factors modulate, for example, the activation of autonomic reflex arches, which in turn influence peripheral immune responses and various signaling mechanisms, including neurotransmitters, neuromodulators, and the behavior of specific adrenergic receptors [8]. In this context, the cardiovascular autonomic domain appears to be particularly vulnerable to the effects of a SARS-CoV-2 infection [9,10].…”