Cargando…

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

OBJECTIVE: To study whether combining vital signs and electrocardiogram (ECG) analysis can improve early prognostication. METHODS: This study analyzed 1258 adults with coronavirus disease 2019 who were seen at three hospitals in New York in March and April 2020. Electrocardiograms at presentation to...

Descripción completa

Detalles Bibliográficos
Autores principales: Elias, Pierre, Poterucha, Timothy J., Jain, Sneha S., Sayer, Gabriel, Raikhelkar, Jayant, Fried, Justin, Clerkin, Kevin, Griffin, Jan, DeFilippis, Ersilia M., Gupta, Aakriti, Lawlor, Matthew, Madhavan, Mahesh, Rosenblum, Hannah, Roth, Zachary B., Natarajan, Karthik, Hripcsak, George, Perotte, Adler, Wan, Elaine Y., Saluja, Amardeep, Dizon, Jose, Ehlert, Frederick, Morrow, John P., Yarmohammadi, Hirad, Kumaraiah, Deepa, Redfors, Bjorn, Gavin, Nicholas, Kirtane, Ajay, Rabbani, Leroy, Burkhoff, Dan, Moses, Jeffrey, Schwartz, Allan, Leon, Martin, Uriel, Nir
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Mayo Foundation for Medical Education and Research 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7428764/
https://www.ncbi.nlm.nih.gov/pubmed/33012341
http://dx.doi.org/10.1016/j.mayocp.2020.07.028
_version_ 1783571149081280512
author Elias, Pierre
Poterucha, Timothy J.
Jain, Sneha S.
Sayer, Gabriel
Raikhelkar, Jayant
Fried, Justin
Clerkin, Kevin
Griffin, Jan
DeFilippis, Ersilia M.
Gupta, Aakriti
Lawlor, Matthew
Madhavan, Mahesh
Rosenblum, Hannah
Roth, Zachary B.
Natarajan, Karthik
Hripcsak, George
Perotte, Adler
Wan, Elaine Y.
Saluja, Amardeep
Dizon, Jose
Ehlert, Frederick
Morrow, John P.
Yarmohammadi, Hirad
Kumaraiah, Deepa
Redfors, Bjorn
Gavin, Nicholas
Kirtane, Ajay
Rabbani, Leroy
Burkhoff, Dan
Moses, Jeffrey
Schwartz, Allan
Leon, Martin
Uriel, Nir
author_facet Elias, Pierre
Poterucha, Timothy J.
Jain, Sneha S.
Sayer, Gabriel
Raikhelkar, Jayant
Fried, Justin
Clerkin, Kevin
Griffin, Jan
DeFilippis, Ersilia M.
Gupta, Aakriti
Lawlor, Matthew
Madhavan, Mahesh
Rosenblum, Hannah
Roth, Zachary B.
Natarajan, Karthik
Hripcsak, George
Perotte, Adler
Wan, Elaine Y.
Saluja, Amardeep
Dizon, Jose
Ehlert, Frederick
Morrow, John P.
Yarmohammadi, Hirad
Kumaraiah, Deepa
Redfors, Bjorn
Gavin, Nicholas
Kirtane, Ajay
Rabbani, Leroy
Burkhoff, Dan
Moses, Jeffrey
Schwartz, Allan
Leon, Martin
Uriel, Nir
author_sort Elias, Pierre
collection PubMed
description OBJECTIVE: To study whether combining vital signs and electrocardiogram (ECG) analysis can improve early prognostication. METHODS: This study analyzed 1258 adults with coronavirus disease 2019 who were seen at three hospitals in New York in March and April 2020. Electrocardiograms 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 of 1258 patients (5.8%) had died and 174 of 1258 (13.8%) were alive but receiving mechanical ventilation with 277 of 1258 (22.0%) 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 (odds ratio [OR], 2.5; 95% CI, 1.1 to 6.2), right ventricular strain (OR, 2.7; 95% CI, 1.3 to 6.1), and ST segment abnormalities (OR, 2.4; 95% CI, 1.5 to 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 <20 breaths/min and saturation >95%), only 5 (4.6%) died or required mechanical ventilation by 48 hours versus 68 of 216 patients (31.5%) having both ECG and respiratory vital sign abnormalities. CONCLUSION: 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 coronavirus disease 2019 and may assist with patient triage.
format Online
Article
Text
id pubmed-7428764
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Mayo Foundation for Medical Education and Research
record_format MEDLINE/PubMed
spelling pubmed-74287642020-08-17 The Prognostic Value of Electrocardiogram at Presentation to Emergency Department in Patients With COVID-19 Elias, Pierre Poterucha, Timothy J. Jain, Sneha S. Sayer, Gabriel Raikhelkar, Jayant Fried, Justin Clerkin, Kevin Griffin, Jan DeFilippis, Ersilia M. Gupta, Aakriti Lawlor, Matthew Madhavan, Mahesh Rosenblum, Hannah Roth, Zachary B. Natarajan, Karthik Hripcsak, George Perotte, Adler Wan, Elaine Y. Saluja, Amardeep Dizon, Jose Ehlert, Frederick Morrow, John P. Yarmohammadi, Hirad Kumaraiah, Deepa Redfors, Bjorn Gavin, Nicholas Kirtane, Ajay Rabbani, Leroy Burkhoff, Dan Moses, Jeffrey Schwartz, Allan Leon, Martin Uriel, Nir Mayo Clin Proc Original Article OBJECTIVE: To study whether combining vital signs and electrocardiogram (ECG) analysis can improve early prognostication. METHODS: This study analyzed 1258 adults with coronavirus disease 2019 who were seen at three hospitals in New York in March and April 2020. Electrocardiograms 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 of 1258 patients (5.8%) had died and 174 of 1258 (13.8%) were alive but receiving mechanical ventilation with 277 of 1258 (22.0%) 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 (odds ratio [OR], 2.5; 95% CI, 1.1 to 6.2), right ventricular strain (OR, 2.7; 95% CI, 1.3 to 6.1), and ST segment abnormalities (OR, 2.4; 95% CI, 1.5 to 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 <20 breaths/min and saturation >95%), only 5 (4.6%) died or required mechanical ventilation by 48 hours versus 68 of 216 patients (31.5%) having both ECG and respiratory vital sign abnormalities. CONCLUSION: 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 coronavirus disease 2019 and may assist with patient triage. Mayo Foundation for Medical Education and Research 2020-10 2020-08-15 /pmc/articles/PMC7428764/ /pubmed/33012341 http://dx.doi.org/10.1016/j.mayocp.2020.07.028 Text en © 2020 Mayo Foundation for Medical Education and Research. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Original Article
Elias, Pierre
Poterucha, Timothy J.
Jain, Sneha S.
Sayer, Gabriel
Raikhelkar, Jayant
Fried, Justin
Clerkin, Kevin
Griffin, Jan
DeFilippis, Ersilia M.
Gupta, Aakriti
Lawlor, Matthew
Madhavan, Mahesh
Rosenblum, Hannah
Roth, Zachary B.
Natarajan, Karthik
Hripcsak, George
Perotte, Adler
Wan, Elaine Y.
Saluja, Amardeep
Dizon, Jose
Ehlert, Frederick
Morrow, John P.
Yarmohammadi, Hirad
Kumaraiah, Deepa
Redfors, Bjorn
Gavin, Nicholas
Kirtane, Ajay
Rabbani, Leroy
Burkhoff, Dan
Moses, Jeffrey
Schwartz, Allan
Leon, Martin
Uriel, Nir
The Prognostic Value of Electrocardiogram at Presentation to Emergency Department in Patients With COVID-19
title The Prognostic Value of Electrocardiogram at Presentation to Emergency Department in Patients With COVID-19
title_full The Prognostic Value of Electrocardiogram at Presentation to Emergency Department in Patients With COVID-19
title_fullStr The Prognostic Value of Electrocardiogram at Presentation to Emergency Department in Patients With COVID-19
title_full_unstemmed The Prognostic Value of Electrocardiogram at Presentation to Emergency Department in Patients With COVID-19
title_short The Prognostic Value of Electrocardiogram at Presentation to Emergency Department in Patients With COVID-19
title_sort prognostic value of electrocardiogram at presentation to emergency department in patients with covid-19
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7428764/
https://www.ncbi.nlm.nih.gov/pubmed/33012341
http://dx.doi.org/10.1016/j.mayocp.2020.07.028
work_keys_str_mv AT eliaspierre theprognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT poteruchatimothyj theprognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT jainsnehas theprognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT sayergabriel theprognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT raikhelkarjayant theprognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT friedjustin theprognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT clerkinkevin theprognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT griffinjan theprognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT defilippisersiliam theprognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT guptaaakriti theprognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT lawlormatthew theprognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT madhavanmahesh theprognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT rosenblumhannah theprognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT rothzacharyb theprognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT natarajankarthik theprognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT hripcsakgeorge theprognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT perotteadler theprognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT wanelainey theprognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT salujaamardeep theprognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT dizonjose theprognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT ehlertfrederick theprognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT morrowjohnp theprognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT yarmohammadihirad theprognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT kumaraiahdeepa theprognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT redforsbjorn theprognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT gavinnicholas theprognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT kirtaneajay theprognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT rabbanileroy theprognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT burkhoffdan theprognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT mosesjeffrey theprognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT schwartzallan theprognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT leonmartin theprognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT urielnir theprognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT eliaspierre prognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT poteruchatimothyj prognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT jainsnehas prognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT sayergabriel prognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT raikhelkarjayant prognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT friedjustin prognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT clerkinkevin prognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT griffinjan prognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT defilippisersiliam prognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT guptaaakriti prognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT lawlormatthew prognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT madhavanmahesh prognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT rosenblumhannah prognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT rothzacharyb prognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT natarajankarthik prognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT hripcsakgeorge prognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT perotteadler prognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT wanelainey prognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT salujaamardeep prognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT dizonjose prognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT ehlertfrederick prognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT morrowjohnp prognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT yarmohammadihirad prognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT kumaraiahdeepa prognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT redforsbjorn prognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT gavinnicholas prognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT kirtaneajay prognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT rabbanileroy prognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT burkhoffdan prognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT mosesjeffrey prognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT schwartzallan prognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT leonmartin prognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19
AT urielnir prognosticvalueofelectrocardiogramatpresentationtoemergencydepartmentinpatientswithcovid19