Is the heart rate variability monitoring using the analgesia nociception index a predictor of illness severity and mortality in critically ill patients with COVID-19? A pilot study

Abstract

Introduction The analysis of heart rate variability (HRV) has proven to be an important tool for the management of autonomous nerve system in both surgical and critically ill patients. We conducted this study to show the different spectral frequency and time domain parameters of HRV as a prospective predictor for critically ill patients, and in particular for COVID-19 patients who are on mechanical ventilation. The hypothesis is that most severely ill COVID-19 patients have a depletion of the sympathetic nervous system and a predominance of parasympathetic activity reflecting the remaining compensatory anti-inflammatory response. Materials and methods A single-center, prospective, observational pilot study which included COVID-19 patients admitted to the Surgical Intensive Care Unit was conducted. The normalized high-frequency component (HFnu), i.e. ANIm, and the standard deviation of RR intervals (SDNN), i.e. Energy, were recorded using the analgesia nociception index monitor (ANI). To estimate the severity and mortality we used the SOFA score and the date of discharge or date of death. Results A total of fourteen patients were finally included in the study. ANIm were higher in the non-survivor group (p = 0.003) and were correlated with higher IL-6 levels (p = 0.020). Energy was inversely correlated with SOFA (p = 0.039) and fewer survival days (p = 0.046). A limit value at 80 of ANIm, predicted mortalities with a sensitivity of 100% and specificity of 85.7%. In the case of Energy, a limit value of 0.41 ms predicted mortality with all predictive values of 71.4%. Conclusion A low autonomic nervous system activity, i.e. low SDNN or Energy, and a predominance of the parasympathetic system, i.e. low HFnu or ANIm, due to the sympathetic depletion in COVID-19 patients are associated with a worse prognosis, higher mortality, and higher IL-6 levels.

Heart rate variability changes in mild-symptomatic, physically fit male in 4-6 weeks from the end of SARS-Cov-2 infection

“…Its drops preceded an increase of the in ammatory marker CRP [8]. SDNN as well as other spectral parameters were shown as predictors of illness severity and mortality in critically ill patients with COVID-19 [9]. The studies of Aragón-Benedí et al…”

“…Its drops preceded an increase of the in ammatory marker CRP [8]. SDNN as well as other spectral parameters were shown as predictors of illness severity and mortality in critically ill patients with COVID-19 [9]. The studies of Aragón-Benedí et al [9] and Kaliyaperumal et al [10] showed an increase in parasympathetic activity and a decrease in sympathetic activity re ecting a compensatory anti-in ammatory response in patients who died due to infection.…”

“…SDNN as well as other spectral parameters were shown as predictors of illness severity and mortality in critically ill patients with COVID-19 [9]. The studies of Aragón-Benedí et al [9] and Kaliyaperumal et al [10] showed an increase in parasympathetic activity and a decrease in sympathetic activity re ecting a compensatory anti-in ammatory response in patients who died due to infection. Single clinical cases of continuous monitoring of the patient during the in ammation process of COVID-19 were also reported, where a parallel decrease in the heart rate (HR) and SDNN at the onset of the disease were found [11].…”

“…Differences in the autonomic responses between patients with COVID-19 in relation to patients with sepsis (due to various causes) have also been described, indicating the unique expression of SARS-CoV-2 infection [12]. More detailed discussion about the prognostic value of HRV markers and their correlations with in ammatory markers in COVID-19 disease can be found in [9].…”

Auricular Neuromodulation for Mass Vagus Nerve Stimulation: Insights From SOS COVID-19 a Multicentric, Randomized, Controlled, Double-Blind French Pilot Study

“…Several epidemiological studies have shown that reduced HRV is a risk factor for all-cause mortality and morbidity (Liao et al, 2002 ), not only in cardiovascular diseases (Fang et al, 2020 ), metabolic diseases (Pavlov, 2021 ), and neurodegenerative diseases (Rangon et al, 2020 ), but also in acute respiratory distress syndrome (ARDS) (Chen et al, 2018 ), sepsis (De Castilho et al, 2018 ; Barnaby et al, 2019 ), and the severe infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Hasty et al, 2020 ; Leitzke et al, 2020 ; Aragon-Benedi et al, 2021 ; Pan et al, 2021 ).…”