Heart Rate Variability as a Possible Predictive Marker for Acute Inflammatory Response in COVID-19 Patients.
Heart Rate Variability as a Possible Predictive Marker for Acute Inflammatory Response in COVID-19 Patients.
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DOI：
10.1093/milmed/usaa405
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发表时间：
2021-01-30
影响因子：
1.2
通讯作者：
Chong S
中科院分区：
文献类型：
--
作者：
Hasty F;García G;Dávila H;Wittels SH;Hendricks S;Chong S
C反应蛋白（CRP）的增加被用于跟踪COVID-19的炎症过程，并与疾病状态进展相关。心率变异性（HRV）的降低与疾病状态的恶化相关。这项观察性研究追踪了COVID-19患者HRV相对于CRP变化的变化。根据机构审查委员会批准的一项研究，17名患者使用可穿戴的非侵入性Tiger Tech Warfighter Monitor（WFM）进行随访，该监视器记录单肢心电图的HRV。分析了至少7天内5至7分钟的间歇性每日短节段数据集。将HRV的变化与CRP的变化进行比较。在随后的72小时内，12例CRP急剧升高的患者中有10例的HRV下降超过40%，CRP升高50%。评价了HRV作为CRP升高领先指标的有效性;在CRP升高50%之前HRV降低40%的敏感性、特异性、阳性预测值和阴性预测值分别为83.3%、75%、90.9%和60%。在随后的72小时内，HRV显著降低先于CRP升高，阳性预测值为90.9%。早期发现炎症增加可能对减轻异常炎症反应的有害影响至关重要，特别是在COVID-19患者中。这种能力可能会对主要医疗中心和野战医院的中重度COVID-19患者的分诊和护理产生重大影响。这项研究证明了短段间歇性HRV分析在COVID-19患者中的潜在价值。
Increases in C-reactive protein (CRP) are used to track the inflammatory process of COVID-19 and are associated with disease state progression. Decreases in heart rate variability (HRV) correlate with worsening of disease states. This observational study tracks changes in HRV relative to changes in CRP in COVID-19 patients. In accordance with an Institutional Review Board-approved study, 17 patients were followed using the wearable, noninvasive Tiger Tech Warfighter Monitor (WFM) that records HRV from a single limb electrocardiogram. Intermittent, daily short-segment data sets of 5 to 7 minutes over a minimum of 7 days were analyzed. Changes in HRV were compared to changes in CRP. Decreases in HRV of greater than 40% preceded a 50% increase in CRP during the ensuing 72 hours in 10 of the 12 patients who experienced a dramatic rise in CRP. The effectiveness of HRV as a leading indicator of a rise in CRP was evaluated; the sensitivity, specificity, positive predictive value, and negative predictive value for 40% decreases in HRV preceding 50% increases in CRP were 83.3%, 75%, 90.9%, and 60%, respectively. Substantial decreases in HRV preceded elevations in CRP in the ensuing 72 hours with a 90.9% positive predictive value. Early detection of increasing inflammation may prove vital in mitigating the deleterious effects of an abnormal inflammatory response, particularly in COVID-19 patients. This capability could have a major impact in triage and care of moderate to severe COVID-19 patients in major medical centers as well as field hospitals. This study demonstrates the potential value of short-segment, intermittent HRV analysis in COVID-19 patients.
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