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Healthcare delivery, economics and global health
Original research
Delayed cardiac repolarisation as a predictor of in-hospital mortality in patients with COVID-19
  1. Joanna Fishbein1,
  2. Kristie M Coleman2,
  3. Amarbir Bhullar2,
  4. Nikhil Sharma2,
  5. Stefanos Zafeiropoulos1,
  6. Umair Ansari2,
  7. Tia Bimal2,
  8. Yan Liu1,
  9. Stavros E Mountantonakis2
  1. 1 Northwell Health Feinstein Institutes for Medical Research, Manhasset, New York, USA
  2. 2 Department of Cardiac Electrophysiology, Northwell Health, Lenox Hill Heart and Vascular Institute, New York, New York, USA
  1. Correspondence to Kristie M Coleman, Department of Cardiac Electrophysiology, Northwell Health, Lenox Hill Heart and Vascular Institute, New York, New York, USA; kcoleman1{at}northwell.edu

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

Data availability statement

Data are available on reasonable request.

This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/heartjnl-2021-320412

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    Data availability statement

    Data are available on reasonable request.

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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.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.