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 Table of Contents  
Year : 2020  |  Volume : 2  |  Issue : 4  |  Page : 67-68

Heart Rate Variability: A Potential Noninvasive Biomarker in Viral Sepsis by COVID19 Infection

1 Center of Biomedical Research, Faculty of Medicine, University of Cartagena; Department of Neurocritical Care, Latinamerican Council of Neurocritical Care, Cartagena, Colombia
2 Neurocritical Care, Critical Care Unit, Regions Hospitals, Saint Paul, Minnesota, USA
3 Department of Neurocritical Care, Latinamerican Council of Neurocritical Care, Cartagena; Department of Medicine, Soutcolombian University, Neiva, Colombia
4 Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India

Date of Submission17-May-2020
Date of Acceptance20-Aug-2020
Date of Web Publication25-Jun-2021

Correspondence Address:
Dr. Luis Rafael Moscote-Salazar
Department of Neurosurgery, University of Cartagena, Cra. 50 #24120, Cartagena De Indias
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jtccm.jtccm_3_20

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How to cite this article:
Moscote-Salazar LR, Janjua T, Florez-Perdomo WA, Garcia-Ballestas E, Amit A. Heart Rate Variability: A Potential Noninvasive Biomarker in Viral Sepsis by COVID19 Infection. J Transl Crit Care Med 2020;2:67-8

How to cite this URL:
Moscote-Salazar LR, Janjua T, Florez-Perdomo WA, Garcia-Ballestas E, Amit A. Heart Rate Variability: A Potential Noninvasive Biomarker in Viral Sepsis by COVID19 Infection. J Transl Crit Care Med [serial online] 2020 [cited 2023 Mar 31];2:67-8. Available from: http://www.tccmjournal.com/text.asp?2020/2/4/67/319413

The sudden outbreak caused by the so-called SARS-CoV-2 has spread globally.[1] The new virus belongs to the Orthocoronavirinae subfamily, family coronaviridae, order nidovirales.[2],[3] It has been estimated that a considerable number of patients (up to 12%%) are admitted to intensive care units and with the number of patients progress to severe condition associated with an exaggerated systemic inflammatory response that darkens the outcome.[4] Unlike the other SARSs, the COVID19 data from Wuhan (Hubei province, China) has shown that the disease is known to affect males (68%) and middle-aged adults in the age group of 50–59 years.[2] The estimated prevalence is 10% in patients <39 years.[3] Timely management of multiple organ failure and associated sepsis are determining factors in treatment. The release of proinflammatory cytokines, chemokines, interferons, and macrophages has been observed.[5] The cytokine storm caused by viral invasion may play a role in COVID19 pathobiology.

The identification of noninvasive biomarkers is necessary for the management of this complex condition. In patients with heart failure, acute myocardial infarction, among other pathologies, a relationship has been found between heart rate variability (HRV) and outcome.[6] The HRV is a representation of autonomic dysfunction. Heart rate is a dynamic event with temporal changes. HRV is defined as the variation in a certain period of heartbeats over time; this phenomenon is managed by extracardiac physiological mechanisms.[7] HRV decreases in patients who present with acute myocardial infarction and is a predictor of arrhythmias and cardiac arrest.[8],[9]

In the group of patients with severe illnesses, severe metabolic disturbance (acidosis) has been observed that can correspond to alteration of the microcirculation.[5] Clinically, these patients present with hypotension, a weak pulse in the context of mixed shock.[5] Some authors have reported that HRV may be an early predictor of septic shock and multiple organ dysfunction.[10],[11],[12] The aggressive inflammatory response observed in some patients infected with coronavirus can lead to myocardial ischemia in previously ill coronaries and also affect ventricular function in the early stages of sepsis.[12] We believe that the early characterization of a group of patients who progress to shock and multiple organ dysfunction with noninvasive physiological biomarkers will allow goal-oriented critical management strategies to be established that will offer targeted treatment to each patient.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.  Back to cited text no. 1
de Groot RJ, Baker SC, Baric R, Enjuanes L, Gorbalenya AE, Holmes KV et al. Family - Coronaviridae. In: King AM, Lefkowitz EJ, Adams MJ, Carstens EB, editors. Virus Taxonomy Ninth Report of the International Committee on Taxonomy of Viruses. CA: Elsevier; 2011. p. 806-28.  Back to cited text no. 2
Docea AO, Tsatsakis A, Albulescu D, Cristea O, Zlatian O, Vinceti M, et al. A new threat from an old enemy: Re-emergence of coronavirus (Review). Int J Mol Med 2020;45:1631-43.  Back to cited text no. 3
Remuzzi A, Remuzzi G. COVID-19 and Italy: What next? Lancet 2020;395:1225-8.  Back to cited text no. 4
Li H, Liu L, Zhang D, Xu J, Dai H, Tang N, et al. SARS-CoV-2 and viral sepsis: Observations and hypotheses. Lancet 2020;395:1517-20.  Back to cited text no. 5
Stein PK, Domitrovich PP, Kleiger RE, CAST Investigators. Including patients with diabetes mellitus or coronary artery bypass grafting decreases the association between heart rate variability and mortality after myocardial infarction. Am Heart J 2004;147:309-16.  Back to cited text no. 6
Saul J. Beat-to-beat variations of heart rate reflect modulation of cardiac autonomic outflow. Physiology 1990;5:32.  Back to cited text no. 7
Karcz M, Chojnowska L, Zareba W, Ruzyłło W. Prognostic significance of heart rate variability in dilated cardiomyopathy. Int J Cardiol 2003;87:75-81.  Back to cited text no. 8
Stein KM, Borer JS, Hochreiter C, Okin PM, Herrold EM, Devereux RB, et al. Prognostic value and physiological correlates of heart rate variability in chronic severe mitral regurgitation. Circulation 1993;88:127-35.  Back to cited text no. 9
Piepoli M, Garrard CS, Kontoyannis DA, Bernardi L. Autonomic control of the heart and peripheral vessels in human septic shock. Intensive Care Med 1995;21:112-9.  Back to cited text no. 10
Soriano F, Nogueira A, Cappi S, Lins M, Hoshino W, Gonzaga L. Heart dysfunction and heart rate variability prognoses in sepsis. Crit Care. 2004;8(Suppl 1):P75. doi:10.1186/cc2542.  Back to cited text no. 11
Poelaert J, Declerck C, Vogelaers D, Colardyn F, Visser CA. Left ventricular systolic and diastolic function in septic shock. Intensive Care Med 1997;23:553-60.  Back to cited text no. 12


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