Article Text
Abstract
Objective With the rapid influx of COVID-19 admissions during the first wave of the pandemic, there was an obvious need for an efficient and streamlined risk stratification tool to aid in triaging. To this date, no clinical prediction tool exists for patients presenting to the hospital with COVID-19 infection.
Methods This is a retrospective cohort study of patients admitted in one of 13 Northwell Health Hospitals, located in the wider New York Metropolitan area between 1 March 2020 and 27 April 2020. Inclusion criteria were a positive SARS-CoV-2 nasal swab, a 12-lead ECG within 48 hours, and a complete basic metabolic panel within 96 hours of presentation.
Results All-cause, in-hospital mortality was 27.1% among 7098 patients. Independent predictors of mortality included demographic characteristics (male gender, race and increased age), presenting vitals (oxygen saturation <92% and heart rate >120 bpm), metabolic panel values (serum lactate >2.0 mmol/L, sodium >145, mmol/L, blood urea nitrogen >40 mmol/L, aspartate aminotransferase >40 U/L, Creatinine >1.3 mg/dL and glycose >100 mg/L) and comorbidities (congestive heart failure, chronic obstructive pulmonary disease and coronary artery disease). In addition to those, our analysis showed that delayed cardiac repolarisation (QT corrected for heart rate (QTc) >500 ms) was independently associated with mortality (OR 1.41, 95% CI 1.05 to 1.90). Previously mentioned parameters were incorporated into a risk score that accurately predicted in-hospital mortality (AUC 0.78).
Conclusion In the largest cohort of COVID-19 patients with complete ECG data on presentation, we found that in addition to demographics, presenting vitals, clinical history and basic metabolic panel values, QTc >500 ms is an independent risk factor for in-hospital mortality.
- risk factors
- COVID-19
- electrophysiology
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Footnotes
JF and KMC are joint first authors.
Twitter @kcole_12, @amarbir88, @NikhilDSharmaMD, @stefzafeirop, @keepinrhythm
JF and KMC contributed equally.
Contributors SEM and JF conceptualised and designed the study. SEM and JF had full access to all data in the study and take responsibility for the integrity ofthe data and the accuracy of the data analysis. JF performed data cleaning, model design, development, training, optimisation and validation. KMC, AB, and NS wrote the draft of the manuscript. JF, SEM and KC designed and created all figures. YL, SZ, TB and UA critically reviewed the paper and provided advice over a period of several months. All authors approved the final submitted research manuscript and agree to be personally accountable for their contribution and for the academic integrity of the work. SEM accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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