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Heart Rate Variability as a Possible Predictive Marker for Acute Inflammatory Response in COVID-19 Patients
Frederick Hasty1,2,3,4, Guillermo García1,2,3,4, Héctor Dávila1,2,3,4
1Attending Anesthesiologist, Miami Beach Anesthesiology Associates, Inc., Division of Anesthesiology, Mount Sinai Medical Center, Miami Beach, FL 33140, USA.
Insights
Decreases in heart rate variability (HRV) can predict rising C-reactive protein (CRP) inflammation in COVID-19 patients by up to 72 hours. This early warning may improve patient triage and care during inflammatory responses.
Area of Science:
- Biomedical Engineering
- Cardiology
- Infectious Diseases
Background:
- C-reactive protein (CRP) levels indicate COVID-19 inflammation and disease progression.
- Decreased heart rate variability (HRV) correlates with worsening disease states.
Purpose of the Study:
- To investigate the relationship between HRV changes and CRP levels in COVID-19 patients.
- To evaluate HRV as a potential early indicator of increasing inflammation.
Main Methods:
- Observational study involving 17 COVID-19 patients.
- Utilized the wearable, noninvasive Tiger Tech Warfighter Monitor (WFM) for HRV data.
- Analyzed short-segment, intermittent HRV data over a minimum of 7 days.
- Compared changes in HRV with concurrent changes in CRP levels.
Main Results:
- A decrease in HRV greater than 40% preceded a 50% increase in CRP within 72 hours in 10 of 12 patients.
- The sensitivity, specificity, and positive predictive value of HRV as a leading indicator were 83.3%, 75%, and 90.9%, respectively.
- HRV demonstrated a 90.9% positive predictive value for predicting subsequent CRP elevation.
Conclusions:
- Significant HRV decreases can precede CRP elevations by up to 72 hours.
- Short-segment, intermittent HRV analysis shows potential for early inflammation detection in COVID-19.
- This capability may significantly impact the triage and care of COVID-19 patients, especially those with moderate to severe illness.
Introduction:
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.
Materials And Methods:
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.
Results:
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.
Conclusion:
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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