The Prognostic Value of Electrocardiogram at Presentation to Emergency Department in Patients With COVID-19

ABSTRACT Background Rapid risk stratification is essential during the COVID-19 pandemic We aimed to study whether combining vital signs and electrocardiogram (ECG) analysis can improve early prognostication Methods 1,258 adults with COVID-19 seen at three hospitals in New York in March and April 2020 were analyzed ECGs at presentation to the emergency department were systematically read by electrophysiologists The primary outcome was a composite of mechanical ventilation or death 48 hours from diagnosis The prognostic value of ECG abnormalities was assessed in a model adjusted for demographics, comorbidities, and vital signs Results At 48 hours, 73 patients (6%) had died and 174 (14%) were alive but receiving mechanical ventilation with 277 (22%) patients dying by 30 days Early development of respiratory failure was common, with 53% of all intubations occurring within 48 hours of presentation In a multivariable logistic regression, atrial fibrillation/flutter (OR 2 5, 95% CI [1 1-6 2]), right ventricular strain (OR 2 7, 95% CI [1 3-6 1]), and ST segment abnormalities (OR 2 4, 95% CI [1 5-3 8]) were associated with death or mechanical ventilation at 48 hours In 108 patients without these ECG abnormalities and with normal respiratory vitals (rate 95%), only 5 (5%) died or required mechanical ventilation by 48 hours versus 68 of 216 patients (31%) having both ECG and respiratory vital sign abnormalities Conclusions The combination of abnormal respiratory vital signs and ECG findings of atrial fibrillation/flutter, right ventricular strain, or ST segment abnormalities accurately prognosticates early deterioration in patients with COVID-19 and may assist with patient triage