Fragmented QRS is a marker of mortality in patients with severe COVID-19: A retrospective observational study
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2021
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Abstract
Objective: In this study, we aimed to investigate the association of fragmented QRS (f-QRS) with in-hospital death in patients with severe novel coronavirus disease 2019 (COVID-19). Methods: This was a retrospective and observational study. A total of 201 consecutive patients with severe COVID-19 were enrolled. Demographic data, laboratory parameters, medications, electrocardiographic (ECG) findings, and clinical outcomes were recorded. Patients with and without f-QRS were compared, and predictors of all-cause in-hospital mortality were analyzed. Results: A total of 135 patients without f-QRS (mean age of 64 years, 43% women) and 66 patients with f-QRS (mean age of 66 years, 39% women) were included. C-reactive protein (CRP), D-dimer, troponin I, ferritin levels, and CRP to albumin ratio were significantly higher in patients with f-QRS. The need for invasive mechanical ventilation (63.6% vs. 41.5%, p=0.003) and all-cause in-hospital mortality [54.5% vs. 28.9%, log rank p=0.001, relative risk 1.88, 95% confidence interval (CI) 1.16–4.78] were significantly higher in patients with f-QRS. A number value of f-QRS leads ≥2 yields sensitivity and specificity (85.3% and 86.7%, respectively) for predicting in-hospital all-cause mortality. Multivariable analysis showed that f-QRS (odds ratio: 1.041, 95% Cl: 1.021–1.192, p=0.040) were independently associated with in-hospital death. Conclusion: This study revealed that the presence of f-QRS in ECG is associated with higher in-hospital all-cause mortality in patients with severe COVID-19. f-QRS is an easily applicable simple indicator to predict the risk of death in these patients. ©Copyright 2021 by Turkish Society of Cardiology
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Aged , COVID-19 , Electrocardiography , Female , Hospital Mortality , Humans , Male , Middle Aged , Retrospective Studies , SARS-CoV-2 , acetylsalicylic acid , alanine aminotransferase , albumin , aldosterone antagonist , angiotensin receptor antagonist , antihypertensive agent , antilipemic agent , aspartate aminotransferase , azithromycin , beta adrenergic receptor blocking agent , biological marker , C reactive protein , calcium , cardiovascular agent , clopidogrel , creatinine , D dimer , dihydropyridine calcium channel blocker , dipeptidyl carboxypeptidase inhibitor , favipiravir , ferritin , fragmented qrs , hemoglobin , hydroxychloroquine , hydroxymethylglutaryl coenzyme A reductase inhibitor , non dihydropyridine calcium channel blocker , potassium , steroid , troponin I , unclassified drug , adult , aged , alcohol consumption , anemia , area under the curve , Article , artificial ventilation , atrial fibrillation , atrioventricular block , chronic obstructive lung disease , computer assisted tomography , controlled study , coronary artery bypass graft , coronavirus disease 2019 , diabetes mellitus , diagnostic test accuracy study , diarrhea , electrocardiography , fatigue , female , fever , ground glass opacity , headache , heart atrium contraction , heart disease , human , hyperlipidemia , hypertension , major clinical study , male , middle aged , mortality , myalgia , observational study , percutaneous coronary intervention , peripheral vascular disease , QTc interval , receiver operating characteristic , retrospective study , smoking , sore throat , ST segment depression , thorax pain , electrocardiography , hospital mortality