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Clinical surrogates of dysautonomia predict lethal outcome in COVID-19 on intensive care unit

BACKGROUND: Unpredictable vegetative deteriorations made the treatment of patients with acute COVID-19 on intensive care unit particularly challenging during the first waves of the pandemic. Clinical correlates of dysautonomia and their impact on the disease course in critically ill COVID-19 patient...

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Autores principales: Woo, Marcel Seungsu, Mayer, Christina, Fischer, Marlene, Kluge, Stefan, Roedl, Kevin, Gerloff, Christian, Czorlich, Patrick, Thomalla, Götz, Schulze zur Wiesch, Julian, Schweingruber, Nils
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10157117/
https://www.ncbi.nlm.nih.gov/pubmed/37143130
http://dx.doi.org/10.1186/s42466-023-00243-x
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author Woo, Marcel Seungsu
Mayer, Christina
Fischer, Marlene
Kluge, Stefan
Roedl, Kevin
Gerloff, Christian
Czorlich, Patrick
Thomalla, Götz
Schulze zur Wiesch, Julian
Schweingruber, Nils
author_facet Woo, Marcel Seungsu
Mayer, Christina
Fischer, Marlene
Kluge, Stefan
Roedl, Kevin
Gerloff, Christian
Czorlich, Patrick
Thomalla, Götz
Schulze zur Wiesch, Julian
Schweingruber, Nils
author_sort Woo, Marcel Seungsu
collection PubMed
description BACKGROUND: Unpredictable vegetative deteriorations made the treatment of patients with acute COVID-19 on intensive care unit particularly challenging during the first waves of the pandemic. Clinical correlates of dysautonomia and their impact on the disease course in critically ill COVID-19 patients are unknown. METHODS: We retrospectively analyzed data collected during a single-center observational study (March 2020–November 2021) which was performed at the University Medical Center Hamburg-Eppendorf, a large tertiary medical center in Germany. All patients admitted to ICU due to acute COVID-19 disease during the study period were included (n = 361). Heart rate variability (HRV) and blood pressure variability (BPV) per day were used as clinical surrogates of dysautonomia and compared between survivors and non-survivors at different time points after admission. Intraindividual correlation of vital signs with laboratory parameters were calculated and corrected for age, sex and disease severity. RESULTS: Patients who deceased in ICU had a longer stay (median days ± IQR, survivors 11.0 ± 27.3, non-survivors 14.1 ± 18.7, P = 0.85), in contrast time spent under invasive ventilation was not significantly different (median hours ± IQR, survivors 322 ± 782, non-survivors 286 ± 434, P = 0.29). Reduced HRV and BPV predicted lethal outcome in patients staying on ICU longer than 10 days after adjustment for age, sex, and disease severity. Accordingly, HRV was significantly less correlated with inflammatory markers (e.g. CRP and Procalcitonin) and blood carbon dioxide in non-survivors in comparison to survivors indicating uncoupling between autonomic function and inflammation in non-survivors. CONCLUSIONS: Our study suggests autonomic dysfunction as a contributor to mortality in critically ill COVID-19 patients during the first waves of the pandemic. Serving as a surrogate for disease progression, these findings could contribute to the clinical management of COVID-19 patients admitted to the ICU. Furthermore, the suggested measure of dysautonomia and correlation with other laboratory parameters is non-invasive, simple, and cost-effective and should be evaluated as an additional outcome parameter in septic patients treated in the ICU in the future.
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spelling pubmed-101571172023-05-05 Clinical surrogates of dysautonomia predict lethal outcome in COVID-19 on intensive care unit Woo, Marcel Seungsu Mayer, Christina Fischer, Marlene Kluge, Stefan Roedl, Kevin Gerloff, Christian Czorlich, Patrick Thomalla, Götz Schulze zur Wiesch, Julian Schweingruber, Nils Neurol Res Pract Research Article BACKGROUND: Unpredictable vegetative deteriorations made the treatment of patients with acute COVID-19 on intensive care unit particularly challenging during the first waves of the pandemic. Clinical correlates of dysautonomia and their impact on the disease course in critically ill COVID-19 patients are unknown. METHODS: We retrospectively analyzed data collected during a single-center observational study (March 2020–November 2021) which was performed at the University Medical Center Hamburg-Eppendorf, a large tertiary medical center in Germany. All patients admitted to ICU due to acute COVID-19 disease during the study period were included (n = 361). Heart rate variability (HRV) and blood pressure variability (BPV) per day were used as clinical surrogates of dysautonomia and compared between survivors and non-survivors at different time points after admission. Intraindividual correlation of vital signs with laboratory parameters were calculated and corrected for age, sex and disease severity. RESULTS: Patients who deceased in ICU had a longer stay (median days ± IQR, survivors 11.0 ± 27.3, non-survivors 14.1 ± 18.7, P = 0.85), in contrast time spent under invasive ventilation was not significantly different (median hours ± IQR, survivors 322 ± 782, non-survivors 286 ± 434, P = 0.29). Reduced HRV and BPV predicted lethal outcome in patients staying on ICU longer than 10 days after adjustment for age, sex, and disease severity. Accordingly, HRV was significantly less correlated with inflammatory markers (e.g. CRP and Procalcitonin) and blood carbon dioxide in non-survivors in comparison to survivors indicating uncoupling between autonomic function and inflammation in non-survivors. CONCLUSIONS: Our study suggests autonomic dysfunction as a contributor to mortality in critically ill COVID-19 patients during the first waves of the pandemic. Serving as a surrogate for disease progression, these findings could contribute to the clinical management of COVID-19 patients admitted to the ICU. Furthermore, the suggested measure of dysautonomia and correlation with other laboratory parameters is non-invasive, simple, and cost-effective and should be evaluated as an additional outcome parameter in septic patients treated in the ICU in the future. BioMed Central 2023-05-04 /pmc/articles/PMC10157117/ /pubmed/37143130 http://dx.doi.org/10.1186/s42466-023-00243-x Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Research Article
Woo, Marcel Seungsu
Mayer, Christina
Fischer, Marlene
Kluge, Stefan
Roedl, Kevin
Gerloff, Christian
Czorlich, Patrick
Thomalla, Götz
Schulze zur Wiesch, Julian
Schweingruber, Nils
Clinical surrogates of dysautonomia predict lethal outcome in COVID-19 on intensive care unit
title Clinical surrogates of dysautonomia predict lethal outcome in COVID-19 on intensive care unit
title_full Clinical surrogates of dysautonomia predict lethal outcome in COVID-19 on intensive care unit
title_fullStr Clinical surrogates of dysautonomia predict lethal outcome in COVID-19 on intensive care unit
title_full_unstemmed Clinical surrogates of dysautonomia predict lethal outcome in COVID-19 on intensive care unit
title_short Clinical surrogates of dysautonomia predict lethal outcome in COVID-19 on intensive care unit
title_sort clinical surrogates of dysautonomia predict lethal outcome in covid-19 on intensive care unit
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10157117/
https://www.ncbi.nlm.nih.gov/pubmed/37143130
http://dx.doi.org/10.1186/s42466-023-00243-x
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