Frontal QRS-T angle as an early predictor of mortality in Sepsis

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.

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.

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.

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.