Mortality Predictors in Patients Diagnosed with COVID-19 in the Emergency Department: ECG, Laboratory and CT
Aslı Türkay Kunt1, Nalan Kozaci1, Ebru Torun2
1Department of Emergency Medicine, Faculty of Medicine, Alanya Alaaddin Keykubat University, Antalya 07450, Turkey.
Insights
Predicting COVID-19 mortality in the emergency department is possible using clinical, lab, and imaging data. Key predictors include peripheral oxygen saturation (SpO2), eosinophil levels, and chest CT findings.
Area of Science:
- Emergency Medicine
- Infectious Diseases
- Cardiology
Background:
- COVID-19 poses a significant mortality risk, necessitating early identification of high-risk patients.
- Emergency departments (ED) are critical points for initial patient assessment and risk stratification.
Purpose of the Study:
- To identify predictive parameters for mortality in COVID-19 patients presenting to the ED.
- To compare clinical, electrocardiogram (ECG), laboratory, and chest computerized tomography (CCT) findings between survivors and non-survivors.
Main Methods:
- Prospective study of 419 COVID-19 patients in the ED, divided into survivor and non-survivor groups.
- Comparison of ECG parameters (QRS, QTc), laboratory markers (WBC, lactate, CRP, hs-Troponin I, etc.), and CCT findings (classified as normal to severe).
Main Results:
- Non-survivors exhibited higher heart rate, respiratory rate, and severe CCT findings (79.2%) compared to survivors (11.5%).
- Lower peripheral oxygen saturation (SpO2) and diastolic blood pressure (DBP) were noted in non-survivors.
- Elevated inflammatory markers (WBC, neutrophil, NLR, CRP), cardiac markers (CK-MB, hs-Troponin I), and impaired gas exchange markers (PCO2, BE, HCO3) were observed in non-survivors.
- Highest predictive value (AUC) was found for SpO2 and eosinophil levels.
Conclusions:
- Mortality risk in COVID-19 patients can be estimated by integrating clinical, laboratory, and imaging data in the ED.
- Pre-oxygen therapy SpO2, eosinophil counts, and CCT findings are crucial predictors of mortality risk.
Abstract:
Background and Objectives: The aim of this study was to investigate parameters that can be used to predict mortality in patients diagnosed with COVID-19 in the emergency department (ED). Materials and Methods: Patients diagnosed with COVID-19 in the ED were included in this prospective study. The patients were divided into two groups. The surviving patients were included in Group 1 (survivors), and the patients who died were included in Group 2 (non-survivors). The electrocardiogram (ECG), laboratory results and chest computerized tomography (CCT) findings of the two groups were compared. The CCT images were classified according to the findings as normal, mild, moderate and severe. Results: Of the 419 patients included in the study, 347 (83%) survived (survivor) and 72 (17%) died (non-survivor). The heart rate and respiratory rate were found to be higher, and the peripheral oxygen saturation (SpO2) and diastolic blood pressure (DBP) were found to be lower in the non-survivor patients. QRS and corrected QT interval (QTc) were measured as longer in the non-survivor patients. In the CCT images, 79.2% of the non-survivor patients had severe findings, while 11.5% of the survivor patients had severe findings. WBC, neutrophil, NLR, lactate, D-dimer, fibrinogen, C- Reactive Protein (CRP), urea, creatinine, creatine kinase-MB (CK-MB) and hs-Troponin I levels were found to be higher and partial pressure of carbon dioxide (PCO2), base excess (BE), bicarbonate (HCO3), lymphocyte eosinophil levels were found to be lower in non-survivor patients. The highest AUC was calculated at the SpO2 level and the eosinophil level. Conclusions: COVID-19 is a fatal disease whose mortality risk can be estimated when the clinical, laboratory and imaging studies of the patients are evaluated together in the ED. SpO2 that is measured before starting oxygen therapy, the eosinophil levels and the CT findings are all important predictors of mortality risk.
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