Why the study?
Myocardial damage indicates poor prognosis in COVID-19, making ECG useful to evaluate the effects of ECG findings on survival in severe disease.
Do pathological ECG findings independently predict mortality in critical COVID-19 patients admitted to the ICU?
Observational (n=193)
No
Do pathological ECG findings independently predict mortality in critical COVID-19 patients admitted to the ICU?
Odds Ratio: 1.99 (95% CI 1.11–3.56)
Absolute Event Rate: 66% vs 51%
p-value: p=0.020
While abnormal ECG findings such as atrial fibrillation and right bundle branch block indicate a poor prognosis in critical COVID-19 patients, they are not independent predictors of mortality when adjusted for other clinical severity markers.
Pathological ECG findings associate with mortality univariably but not independently; leaves open whether they add prognostic value beyond SpO2 and hypertension in critical COVID-19.
Background: Myocardial damage is a sign of poor prognosis in coronavirus disease 2019 (COVID-19). Electrocardiography (ECG) would be useful to evaluate the effects of ECG findings on survival in severe COVID-19. We studied the relationship of pathological ECG findings in patients of COVID-19 admitted in ICU with other adverse physiological parameters as well as the mortality. Methodology: The study population comprised critical COVID-19 patients in the intensive care unit (ICU). Patients with findings other than normal sinus rhythm, atrial extra beat, and ventricular extra beat were defined as patients with pathological ECG findings. Two groups were formed: patients with pathological ECG findings (n = 109) and patients without pathological ECG findings (n = 84). Data were compared and analysed between the groups. The relationship among the risk factors, and ECG findings with mortality was investigated. Results: The presence of hypertension (69% vs. 40%, OR 5.49, CI 1.71-17.66, P = 0.004), peripheral oxygen saturation (SpO2) (88 vs. 95, OR 0.8, CI 0.7-0.9, P < 0.001) were found to be related to mortality in multivariable analyses. Patients with pathological ECG finding were older [74 (27-98) vs. 61 (22-89); P < 0.001], and more likely to have hypertension (68% vs. 44%, P = 0.001). Pathological ECG findings (66% vs. 51%, P = 0.02), atrial fibrillation (AF) (37% vs. 20%, P = 0.01), right branch bundle block (RBBB) (10% vs. 3%, P = 0.048) were associated with higher mortality in univariable analyses. Conclusion: Although abnormal findings on ECG, especially AF and RBBB, are associated with a poor prognosis, they are not primary effective in increasing the mortality of critical COVID-19 patients. Abbreviations: AF- Atrial Fibrillation; CRP- C-reactive protein; ICU- intensive care unit; RBBB- Right Bundle-Branch Block; RT-PCR- reverse-transcription polymerase chain reaction; VTE- venous thromboembolism Key words: Atrial Fibrillation; Biomarkers; COVID-19; ECG; Mortality; Right Bundle-Branch Block Citation: Sayan M, Altinisik HB. The relationship between morphological electrocardiographic characteristics and survival in critical COVID-19 patients. Anaesth. pain intensive care 2024;28(1):139−150. DOI: 10.35975/apic.v28i1.2385 Received: November 21, 2023; Reviewed: November 30, 2023; Accepted: December 21, 2023
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Sayan et al. (2024) conducted an observational in Critical COVID-19 pneumonia (n=193). Pathological ECG findings vs. No pathological ECG findings was evaluated on Mortality (OR 1.99, 95% CI 1.11-3.56, p=0.020).
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