Abstract 16821: An ECG Derived Risk Score Predicts In-Hospital Death in Patients With COVID-19

Abstract

Introduction: COVID-19 is a respiratory syndrome with high rates of mortality, and findings from the ECG on hospital presentation have been shown to increase the odds of death. We thus hypothesized that findings from the presenting ECG could discriminate the risk of death in high risk subgroups, and sought to create an ECG risk score for death in COVID-19. Methods: We performed a retrospective cohort study in patients with COVID-19 who had an ECG at or near hospital admission. Clinical characteristics were manually abstracted from the electronic health record; ECG data were digitally extracted from the first ECG in each patient, and Bazett-corrected QT interval and ST segment deviation at the M-point (STm, in μV) were quantified in all 12 leads. Our primary outcome was death. Results: 710 patients who presented to a large teaching hospital with COVID-19 underwent an ECG. The mean age was 63 ± 16 years, 37% were women, 62% of patients were non-white, and 56% had hypertension; 78 (11%) died. In a multivariable logistic regression that included age, ECG, and clinical characteristics, the presence of one or more atrial premature contractions (OR=3.56, 95% CI 1.80-7.02, p<0.001), a right bundle branch block or intraventricular block (OR=2.73, 95% CI 1.41-5.32, p=0.003), maximal STm in V5 or V6 (STmV5V6) ≤ -50 μV (OR=3.01, 95% CI 1.41-6.41, p=0.004), STmV2 <0 μV (OR=3.41, 95% CI 1.88-6.18, p<0.001), and QTc ≥480 ms (OR=2.84, 95% CI 1.52-5.29, p=0.001) predicted death. When each variable was assigned a point value of 1, in additive fashion an ECG score=1 or ≥2 similarly predicted death (OR=4.49, 95% CI 2.17-9.25, p<0.001 and OR=11.23, 95% CI 5.27-23.93, p<0.001, respectively), and discriminated risk within high risk age groups (<60, 70-80, >80, Figure ). Conclusions: A simple ECG risk score (including APCs, RBBB/IVB, STmV5V6 ≤ -50 μV, STmV2 <0 μV, and QTc ≥480 ms) on initial hospitalization predicted in hospital death in COVID-19, and further discriminated risk of death in high risk age groups.