The Prognostic Value of Electrocardiogram at Presentation to Emergency Department in Patients With COVID-19

The Prognostic Value of Electrocardiogram at Presentation to Emergency Department in Patients With COVID-19 MAYO CLINIC PROCEEDINGS Elias, P., Poterucha, T. J., Jain, S. S., Sayer, G., Raikhelkar, J., Fried, J., Clerkin, K., Griffin, J., DeFilippis, E. M., Gupta, A., Lawlor, M., Madhavan, M., Rosenblum, H., Roth, Z. B., Natarajan, K., Hripcsak, G., Perotte, A., Wan, E. Y., Saluja, A., Dizon, J., Ehlert, F., Morrow, J. P., Yarmohammadi, H., Kumaraiah, D., Redford, B., Gavin, N., Kirtane, A., Rabbani, L., Burkhoff, D., Moses, J., Schwartz, A., Leon, M., Uriel, N. 2020; 95 (10): 2099-2109

Abstract

To study whether combining vital signs and electrocardiogram (ECG) analysis can improve early prognostication.This study analyzed 1258 adults with coronavirus disease 2019 who were seen at three hospitals in New York in March and April 2020. Electrocardiograms at presentation to the emergency department were systematically read by electrophysiologists. The primary outcome was a composite of mechanical ventilation or death 48 hours from diagnosis. The prognostic value of ECG abnormalities was assessed in a model adjusted for demographics, comorbidities, and vital signs.At 48 hours, 73 of 1258 patients (5.8%) had died and 174 of 1258 (13.8%) were alive but receiving mechanical ventilation with 277 of 1258 (22.0%) patients dying by 30 days. Early development of respiratory failure was common, with 53% of all intubations occurring within 48 hours of presentation. In a multivariable logistic regression, atrial fibrillation/flutter (odds ratio [OR], 2.5; 95% CI, 1.1 to 6.2), right ventricular strain (OR, 2.7; 95% CI, 1.3 to 6.1), and ST segment abnormalities (OR, 2.4; 95% CI, 1.5 to 3.8) were associated with death or mechanical ventilation at 48 hours. In 108 patients without these ECG abnormalities and with normal respiratory vitals (rate <20 breaths/min and saturation >95%), only 5 (4.6%) died or required mechanical ventilation by 48 hours versus 68 of 216 patients (31.5%) having both ECG and respiratory vital sign abnormalities.The combination of abnormal respiratory vital signs and ECG findings of atrial fibrillation/flutter, right ventricular strain, or ST segment abnormalities accurately prognosticates early deterioration in patients with coronavirus disease 2019 and may assist with patient triage.

View details for DOI 10.1016/j.mayocp.2020.07.028

View details for Web of Science ID 000581142500014

View details for PubMedID 33012341

View details for PubMedCentralID PMC7428764