ECG pathology and its association with death in critically ill COVID-19 patients, a cohort study
Jacob Rosén1, Maria Noreland2, Karl Stattin1
1Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden.
Insights
Electrocardiogram (ECG) abnormalities like prior myocardial infarction patterns or ST-T changes in severe COVID-19 patients indicate a higher risk of death and organ dysfunction. These ECG findings signal a poor prognosis and need for intensive care.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- COVID-19 patients admitted to the intensive care unit (ICU) often experience cardiac complications.
- The prognostic value of electrocardiogram (ECG) abnormalities in this population requires further investigation.
Purpose of the Study:
- To determine the prevalence of ECG abnormalities in ICU-admitted COVID-19 patients.
- To assess the association between ECG findings and mortality, organ dysfunction, and cardiac biomarkers.
Main Methods:
- A cohort study of COVID-19 patients admitted to a Swedish tertiary hospital ICU.
- ECG, clinical, and laboratory data were collected; ECGs near ICU admission were reviewed by two independent physicians.
Main Results:
- Among 80 patients with evaluable ECGs, 30-day mortality was 28%.
- Prior myocardial infarction patterns (63% mortality) and ST-T abnormalities (50% mortality) were linked to increased 30-day mortality compared to normal ECGs (16%).
- These ECG abnormalities correlated with the need for vasoactive treatment and elevated cardiac biomarkers (troponin-I, NT-pro-BNP) and lactate levels.
Conclusions:
- ECG abnormalities, including prior myocardial infarction patterns and acute ST-T pathology, are associated with adverse outcomes in critically ill COVID-19 patients.
- These findings suggest that ECG findings at ICU admission can help identify patients with a poor prognosis and guide clinical management.
Background:
We investigated the prevalence of ECG abnormalities and their association with mortality, organ dysfunction and cardiac biomarkers in a cohort of COVID-19 patients admitted to the intensive care unit (ICU).
Methods:
This cohort study included patients with COVID-19 admitted to the ICU of a tertiary hospital in Sweden. ECG, clinical data and laboratory findings during ICU stay were extracted from medical records and ECGs obtained near ICU admission were reviewed by two independent physicians.
Results:
Eighty patients had an acceptable ECG near ICU-admission. In the entire cohort 30-day mortality was 28%. Compared to patients with normal ECG, among whom 30-day mortality was 16%, patients with ECG fulfilling criteria for prior myocardial infarction had higher mortality, 63%, odds ratio (OR) 9.61 (95% confidence interval (CI) 2.02-55.6) adjusted for Simplified Acute Physiology Score 3 and patients with ST-T abnormalities had 50% mortality and OR 6.05 (95% CI 1.82-21.3) in univariable analysis. Both prior myocardial infarction pattern and ST-T pathology were associated with need for vasoactive treatment and higher peak plasma levels of troponin-I, NT-pro-BNP (N-terminal pro-Brain Natriuretic Peptide), and lactate during ICU stay compared to patients with normal ECG.
Conclusion:
ECG with prior myocardial infarction pattern or acute ST-T pathology at ICU admission is associated with death, need for vasoactive treatment and higher levels of biomarkers of cardiac damage and strain in severely ill COVID-19 patients, and should alert clinicians to a poor prognosis.
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