Table 1.
Confounders impacting COVID‐19‐related physiological biometrics signatures.
| Specific confounder | Baseline vs response | Impacted readout | Clinical factors possibly impacting biometric measurements |
|---|---|---|---|
| Medications | |||
| Immunosuppression regimes | Baseline | BP | Mainstay immunosuppression regimens include prednisone and tacrolimus which may cause PTDM hypertension and hyperglycemia. Mycophenolate may cause nausea, vomiting, diarrhea, and anemia. Multiple drug–drug interactions |
| Beta blocker | Baseline and response | BP, HR, HRV | Beta blockers to treat hypertension can lower BP and HR, increased HRV, and fatigue. ##Calcium channel antagonists to treat post‐Tx hypertension can also cause low BP and reflex tachycardia |
| Erythropoiesis stimulating agents | Baseline and response | HR, HRV | Post‐transplant anemia can cause elevated HR, irregular HR, fatigue, and shortness of breath which may resolve with erythropoiesis‐stimulating drugs |
| Antivirals | Baseline and response | Multiple | Valganciclovir, a common antiviral for CMV prophylaxis, is associated with multiple GI symptoms, anemia, leukopenia, and thrombocytopenia |
| Antibacterials/Antifungals | Baseline and response | Multiple | Bactrim can cause nausea, vomiting, anemia, and rash. Nystatin can cause diarrhea, nausea, and stomach pain. Antibiotics used to treat post‐transplant bacterial infections are associated with GI symptoms such as diarrhea, nausea, stomach pain, and rash |
| Antidepressants | Baseline | HR, BP | SSRIs can cause nausea, vomiting, diarrhea, appetite change, headache, fatigue and possibly QT prolongation. SNRIs are associated with nausea, constipation, fatigue, urination difficulty, sweating and hypertension with serotonin syndrome. Multiple drug–drug interactions |
| Over‐the‐counter products | Baseline and response | Multiple | Analgesics may reduce fever, cough and cold products may increase HR, antihistamines may cause GI symptoms, fatigue, and irregular HR, antacids may cause GI symptoms, PPIs may cause GI symptoms |
| Underlying infection(s) | |||
| EBV | Baseline and response | Multiple | Can cause fever, changes in HRV that mimic SARS‐CoV‐2 infection. May cause PTLD which presents with fever, weight loss, fatigue |
| CMV | Baseline and response | Multiple | Can cause fever, changes in HRV that mimic SARS‐CoV‐2. Prophylaxis may result in hypertension/hypotension and fever |
| Comorbidities | |||
| PTLD | Baseline and response | Multiple | Fever, weight loss, diarrhea, fatigue |
| Hypertension | Baseline | BP | Post‐transplant hypertension is very common |
| Anemia | Baseline and response | HR, HRV | Anemia results in increased heart rate and reduced heart rate variability |
| PTDM | Baseline and response | Multiple | PTDM is associated with hypertension as well as an increased risk for infection and sepsis, including UTIs, pneumonia, CMV |
| CKD | Baseline and response | BP, HR, HRV | CKD effects physiology, including anemia, dehydration, and electrolyte imbalances, resulting in effects on BP, HR, and HRV |
BP, Blood pressure; CMV, Cytomegalovirus; EBV, Epstein–Barr virus; HR, Heart rate; HR, Heart rate variability; SSRIs, Selective serotonin reuptake inhibitors; SNRIs, Serotonin and norepinephrine reuptake inhibitors; PTDM, Post‐transplant diabetes mellitus; PTLD, Post‐transplant lymphoproliferative disorders; PPI, Proton‐pump inhibitors.
Updated information was taken from McDonald 2020 [44].
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