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Published on: September 21, 2018
Heart rate variability as an early predictor for children with SARS-CoV-2-associated encephalopathy
Yu-Shin Lee1, Hung-Tao Chung1, Shao-Hsuan Hsia2
1Department of Pediatric Cardiology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Insights
Heart rate variability is reduced in children with SARS-CoV-2 infection who develop encephalopathy or severe disease. Lower heart rate variability may indicate a higher risk of progressing to severe neurological complications from COVID-19.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Cardiology
Background:
- SARS-CoV-2 infection can cause serious neurological complications like encephalopathy in children.
- Early identification of children at risk for severe outcomes is crucial.
Purpose of the Study:
- To assess heart rate variability (HRV) in pediatric SARS-CoV-2 patients.
- To identify HRV as a potential predictor for developing SARS-CoV-2-associated encephalopathy.
Main Methods:
- Prospective enrollment of 72 children with confirmed SARS-CoV-2 infection.
- Categorization into encephalopathic and non-encephalopathic groups (mild, moderate, severe/critical).
- Analysis of heart rate variability indices from 1-minute electrocardiography recordings.
Main Results:
- 15 children (20.8%) developed encephalopathy.
- Lower HRV indices (SDNNc, RMSSDc, SD1/SD2 ratio) were observed in the encephalopathic and severe/critical disease groups.
- These findings were compared to mild and moderate non-encephalopathic groups.
Conclusions:
- Significantly reduced heart rate variability is associated with severe COVID-19 and encephalopathy in children.
- HRV warrants further investigation as a potential biomarker for predicting disease progression to encephalopathy.
Background:
Although encephalopathy and encephalitis are uncommon complications of SARS-CoV-2 infection in children, they can lead to significant morbidity and mortality. Therefore, the aim of the study is to assess heart rate variability in children with SARS-CoV-2 infection and determine those at risk of progressing to SARS-CoV-2-associated encephalopathy.
Methods:
Children with confirmed SARS-CoV-2 infection between September 1, 2022 and December 8, 2023 were prospectively enrolled and divided into encephalopathic and non-encephalopathic groups. The non-encephalopathic group was further classified into mild, moderate, and severe/critical disease groups. One-minute electrocardiography was recorded on the first day of admission. Heart rate variability indices were compared between the encephalopathic and non-encephalopathic groups.
Results:
A total of 72 children (30 girls [41.7 %] and 42 boys [58.3 %]) with SARS-CoV-2 infection were enrolled, with age ranging from 1 month to 18 years. Of these children, 15 (20.8 %) were classified into the encephalopathic group, and 57 (79.2 %) were classified into the non-encephalopathic group. We compared heart rate variability indices and found that both time domain analysis (SDNNc and RMSSDc) and nonlinear Poincaré plot analysis (SD1/SD2 ratio) were lower in the encephalopathic group and severe/critical disease group than in the mild and moderate severity non-encephalopathic groups.
Conclusions:
Heart rate variability parameters were significantly lower in the severe/critical disease group and the encephalopathic group compared to the mild to moderate severity groups. The implications of heart rate variability, particularly when considering neurological symptoms, as a predictor of disease progression to encephalopathy require further evaluation.
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