Pre‐pandemic autonomic function as a predictor of the COVID clinical course in young adults

Abstract

AbstractLong coronavirus disease (COVID) is emerging as a common clinical entity in the current era. Autonomic dysfunction is one of the frequently reported post‐COVID complications. We hypothesize a bi‐directional relationship between the autonomic function and the COVID course. This postulation has been inadequately addressed in the literature. A retrospective cohort (pre and post‐comparison) study was conducted on 30 young adults whose pre‐COVID autonomic function test results were available. They were divided into case and control groups based on whether they tested reverse transcription polymerase chain reaction positive for COVID‐19. Autonomic function tests were performed in both the case and control groups. COVID infection in healthy young adults shifts the sympatho–vagal balance from the pre‐disease state. Postural orthostatic tachycardia syndrome was present in 35% of the COVID‐affected group. COVID course parameters were found to be associated with parasympathetic reactivity and the baroreflex function. Baseline autonomic function (parasympathetic reactivity represented by Δ heart rate changes during deep breathing and 30:15 ratio during lying‐to‐standing test) was also associated with the COVID course, the post‐COVID symptoms and the post‐COVID autonomic function profile. Additionally, multiple regression analysis found that the baseline parasympathetic reactivity was a very important determinant of the clinical course of COVID, the post‐COVID symptoms and the post‐COVID autonomic profile. Sympatho–vagal balance shifts to parasympathetic withdrawal with sympathetic predominance due to COVID infection in healthy young adults. There is a bi‐directional relationship between the autonomic function and the COVID course.