Abnormal respiratory vital signs coupled with electrocardiogram (ECG) findings of atrial fibrillation (AF)/flutter, right ventricular (RV) strain, or ST-segment abnormalities were found to predict early deterioration in patients with coronavirus disease 2019 (COVID-19), according to a study published in the Mayo Clinic Proceedings.
Early triage is crucial for hospitalized patients with COVID-19 who require a higher level of care. In this study, researchers examined medical record data from 3 hospitals in New York City, New York to determine whether early data at emergency department presentation could predict the composite outcome of mechanical ventilation or death within the next 48 hours. The data of 1258 adults with COVID-19 (mean age, 61.6 years) who were hospitalized in March and April 2020 were examined.
Electrophysiologists systematically read each patient’s ECG recordings conducted at presentation. A model adjusted for demographics, comorbidities, and vital signs was used to assess the prognostic value of ECG abnormalities. The most common comorbidities in this cohort included hypertension (57%), diabetes (37%), obesity (34%), primary lung disease (17%), and chronic kidney disease (16%).
In this cohort, 73 patients (6%) died within 48 hours of presentation, and 14% of patients (n=174) were still alive at this time but were receiving mechanical ventilation. Another 277 patients (22%) died by 30 days. A total of 53% of all intubations occurred within 48 hours of presentation.
Factors associated with the composite outcome of death or mechanical ventilation within 48 hours were: AF/flutter (odds ratio [OR], 2.5; 95% CI, 1.1-6.2), RV strain (OR, 2.7; 95% CI, 1.3-6.1), and ST-segment abnormalities (OR, 2.4; 95% CI, 95% CI, 1.5-3.8), according to a multivariable logistic regression analysis. Of the 108 patients without ECG abnormalities and with normal respiratory vitals (rate <20 and saturation >95%), 5% had died or required mechanical ventilation by 48 hours compared with 31% of 216 patients who had both ECG and respiratory vital sign abnormalities.
Study limitations include its retrospective nature, the reliance on medical record data, and the lack of outcomes data for patients who remained hospitalized.
“More patients are intubated in the first 24 hours from presentation than any other day, indicating need for rapid triage and raising concerns that some patients are presenting late in their disease course,” noted the study authors,
Elias P, Poterucha TJ, Jain SS, et al. The prognostic value of electrocardiogram at presentation to emergency department in patients with COVID-19. Mayo Clin Proc. Published online July 27, 2020. doi:10.1016/j.mayocp.2020.07.028