Key result
A widened frontal QRS-T angle on admission ECG was an independent predictor of 30-day all-cause mortality in patients with sepsis (HR 2.805; 95% CI 1.797-4.378).
Why the study?
Timely and accurate risk assessment in sepsis remains a major clinical challenge, leading researchers to investigate whether the admission frontal QRS-T angle could serve as an early predictor of outcome.
Does the frontal QRS-T angle obtained upon emergency department admission predict 30-day all-cause mortality in adult patients with sepsis?
Cohort (n=456)
No
Does the frontal QRS-T angle obtained upon emergency department admission predict 30-day all-cause mortality in adult patients with sepsis?
Hazard Ratio: 2.805 (95% CI 1.797–4.378)
p-value: p=< 0.001
The frontal QRS-T angle is an independent, non-invasive predictor of 30-day mortality in sepsis, offering a practical adjunct for early risk stratification.
May enhance sepsis risk stratification via routine ECG; hypothesis-generating until validated in prospective cohorts.
BACKGROUND: Sepsis frequently results in early death, especially among elderly individuals and those with underlying chronic illnesses. Timely and accurate risk assessment remains a major clinical challenge. The frontal QRS-T (F-QRS-T) angle, derived from standart electrocardiograpraphy (ECG), reflects the heterogeneity in ventricular repolarization dynamics, has emerged as a potential prognostic tool in various inflammatory and cardiovascular disorders. This research investigated whether the F-QRS-T angle obtained upon emergency department admission could serve as an early predictor of outcome in sepsis. METHODS: This retrospective cohort study was conducted between September 2022 and September 2024 in a tertiary emergency care facility of a university hospital in Türkiye. Adult patients meeting Sepsis-3 criteria with a 12‑lead ECG recorded within one hour of presentation were included. Demographic, clinical, laboratory, and ECG data were retrieved from electronic health records. The main outcome of interest was all-cause mortality occurring within 30 days of hospital admission. RESULTS: The study cohort comprised 456 individuals, with a mean age of 71.7 ± 13.5 years, and 55.5 % identified as male. Within 30 days, 32.9 % of patients in the cohort had died. Non-survivors had significantly higher F-QRS-T angles than survivors (85.0° vs. 55.2°, p < 0.001). A cut-off value of 43.5° provided the best discrimination for mortality, yielding an AUC of 0.750, sensitivity of 65.4 %, and specificity of 72.2 %. The F-QRS-T angle increased progressively across higher MEWS and qSOFA categories and was significantly elevated in patients with septic shock. In multivariable Cox regression, a widened F-QRS-T angle remained an independent predictor of mortality (HR = 2.805, 95 % CI: 1.797-4.378), alongside elevated CRP, lactate, and MEWS ≥2. CONCLUSION: The frontal QRS-T angle is an independent, non-invasive predictor of 30-day mortality in sepsis. Its routine availability on standard ECGs makes it a practical adjunct to existing scoring systems for early risk stratification in the emergency setting.
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Çaprak et al. (2025) conducted a cohort in Sepsis (n=456). Widened frontal QRS-T angle vs. Narrower frontal QRS-T angle was evaluated on all-cause mortality occurring within 30 days of hospital admission (HR 2.805, 95% CI 1.797-4.378, p=< 0.001). A widened frontal QRS-T angle on admission ECG was an independent predictor of 30-day all-cause mortality in patients with sepsis (HR 2.805; 95% CI 1.797-4.378).
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