The role of ECG as a mortality predictor in COVID-19 patients treated in the intensive care unit

Abstract

Background: COVID-19 infection has reached serious morbidity and mortality rates all over the world for a short time. Many studies have investigated the relationship of COVID-19 disease with mortality and morbidity. In this study, we wanted to elucidate the relationship between rhythm character (sinus rhythm vs atrial fibrillation) and QTc and frontal plane QRS-T angle, which parameters are reflecting the depolarization-repolarization kinetics, and mortality, which were not emphasized enough in previous studies.
 Material and Method: 259 patients admitted to the intensive care unit due to COVID-19 infection between 01.04.2020 and 01.12.2020 was included in the study. The demographic characteristics of the patients, clinical backgrounds, laboratory values ​​at the time of admission to the intensive care unit, and 12 derivation ECG records were obtained from the patient files. Rhythm, PR distance, QRS duration and morphology, QT interval, T wave morphology, presence of atrioventricular (AV) block, QRS axis, presence of ventricular premature contraction, frontal plane QRS-T (f(QRS-T)) angle degree were determined on 12 derivation ECG records. Patient groups were classified as "deceased patient" and "survivors" and the relationship of these parameters with survival was tried to be elucidated.
 Results: the frequency of atrial fibrillation was significantly higher in the "deceased patient" group. For patients in sinus rhythm, there was no difference between the two groups in terms of PR distance and 1st degree AV block. Severe AV block was not observed in either group. There was no difference between the two groups in terms of QRS morphology, T wave inversion, and ventricular premature contractions. QRS duration, corrected QTc duration, and frotal plane QRS-T angle values ​​were found to be statistically significantly higher in in the "deceased patient" group.
 Conclusion: Atrial fibrillation, prolonged QTc duration and increased frontal plane QRS-T angle can be considered as mortality predictors in COVID-19 infection whose mortality rate is high all over the world.