Diagnostic and Immunological Features of Post-Covid-19 Postural Orthostatic Tachycardia Syndrome in Children
Jinny Tavee1, Sarah Petersen2, Sterling Kosmach1, Nathan Rabinovitch1
1National Jewish Health, 2University of Denver
Objective:
To characterize the diagnostic and immunologic features of post-COVID-19 postural orthostatic tachycardia syndrome (POTS) in the pediatric population.
Background:
Post-COVID 19 POTS has been reported in up to 30% of adults following acute COVID infection but is not well-described in the pediatric population. While less common in children, fatigue, dizziness and orthostatic intolerance are increasingly being recognized in patients with post-COVID-19 syndrome that are under 19 years of age.
Design/Methods:
We retrospectively reviewed charts from 39 children with post-COVID-19 syndrome who met the diagnostic criteria for POTS (heart rate increase of 40 beats-per-minute [bpm] over baseline within 10 minutes of standing in the absence of hypotension) by tilt table testing. Fifteen children also underwent quantitative sudomotor axon reflex testing (QSART). Serum cytokine analysis was performed in 19 children and included interleukin 2, 4-6, 10, 12, tumor necrosis factor-alpha and interferon-gamma.
Results:
Median age at diagnosis was 15 years and 74% were female. Most commonly reported symptoms included syncope, dizziness, nausea, and
tachycardia. Tilt table testing demonstrated a median heart rate increase of 53 bpm (range 41 to 88 bpm). Of 15 patients who underwent QSART, 67% demonstrated abnormal sudomotor function, supporting the diagnosis of neurogenic POTS. There was also a direct correlation between increasing TNF-alpha levels and worsening degree of HR changes (Spearman correlation coefficient 0.82, 95
th CI 0.55-0.94, p=0.0001).
Conclusions:
Post-COVID-19 POTS in pediatric patients is most common in female adolescents and causes a complex of symptoms that can significantly affect quality of life. Most of the patients in our series were found to have neurogenic POTS based on QSART. Although the etiology remains unknown, the direct correlation between increasing serum levels of TNF-alpha and worsening degree of heart rate changes may be suggestive of an immune-mediated mechanism for post-COVID POTS in children.