Background

Acute respiratory distress syndrome (ARDS) is considered the main cause of COVID-19 associated morbidity and mortality. Early and reliable risk stratification is of crucial clinical importance in order to identify persons at risk for developing a severe course of disease. Deceleration capacity (DC) of heart rate as a marker of cardiac autonomic function predicts outcome in persons with myocardial infarction and heart failure. We hypothesized that reduced modulation of heart rate may be helpful in identifying persons with COVID-19 at risk for developing ARDS.

Methods

We prospectively enrolled 60 consecutive COVID-19 positive persons presenting at the University Hospital of Tuebingen. Arterial blood gas analysis and 24 h-Holter ECG recordings were performed and analyzed at admission. The primary end point was defined as development of ARDS with regards to the Berlin classification.

Results

61.7% (37 of 60 persons) developed an ARDS. In persons with ARDS DC was significantly reduced when compared to persons with milder course of infection (3.2 ms vs. 6.6 ms, p < 0.001). DC achieved a good discrimination performance (AUC = 0.76) for ARDS in COVID-19 persons. In a multivariate analysis, decreased DC was associated with the development of ARDS.

Conclusion

Our data suggest a promising role of DC to risk stratification in COVID-19.

中文翻译：

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减速能力与 COVID-19 中的急性呼吸窘迫综合征有关

背景

急性呼吸窘迫综合征 (ARDS) 被认为是 COVID-19 相关发病率和死亡率的主要原因。早期和可靠的风险分层对于识别处于发展严重病程风险中的人具有至关重要的临床意义。心率的减速能力 (DC) 作为心脏自主功能的标志可预测心肌梗塞和心力衰竭患者的预后。我们假设减少心率调制可能有助于识别有患 ARDS 风险的 COVID-19 患者。

方法

我们前瞻性地招募了 60 名在图宾根大学医院就诊的连续 COVID-19 阳性患者。在入院时进行动脉血气分析和 24 小时动态心电图记录并进行分析。主要终点被定义为关于柏林分类的 ARDS 的发展。

结果

61.7%（60 人中的 37 人）患上了 ARDS。与感染过程较轻的人相比，ARDS 患者的 DC 显着减少（3.2 毫秒对 6.6 毫秒，p  < 0.001）。DC 在 COVID-19 患者中对 ARDS 取得了良好的辨别性能（AUC = 0.76）。在多变量分析中，DC 降低与 ARDS 的发展相关。

结论

我们的数据表明 DC 在 COVID-19 的风险分层中发挥着重要作用。