Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY; Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY; Department of Medicine, Columbia University Irving Medical Center, New York, NY.
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY; Department of Medicine, Columbia University Irving Medical Center, New York, NY.
Mayo Clin Proc. 2020 Oct;95(10):2099-2109. doi: 10.1016/j.mayocp.2020.07.028. Epub 2020 Aug 15.
To study whether combining vital signs and electrocardiogram (ECG) analysis can improve early prognostication.
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.
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.
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.
研究生命体征与心电图（ECG）分析相结合是否能改善早期预后。
本研究分析了 2020 年 3 月至 4 月期间纽约三家医院的 1258 例成年 2019 冠状病毒病患者。急诊科就诊时的心电图由电生理学家进行系统解读。主要结局是从诊断起 48 小时内需要机械通气或死亡的复合终点。通过调整人口统计学、合并症和生命体征的模型评估心电图异常的预后价值。
在 48 小时时，1258 例患者中有 73 例（5.8%）死亡，1258 例中有 174 例（13.8%）存活但接受机械通气，1258 例中有 277 例（22.0%）患者在 30 天内死亡。呼吸衰竭的早期发生很常见，所有插管中有 53%发生在就诊后 48 小时内。在多变量逻辑回归中，心房颤动/扑动（优势比[OR]，2.5；95%置信区间[CI]，1.1 至 6.2）、右心室应变（OR，2.7；95%CI，1.3 至 6.1）和 ST 段异常（OR，2.4；95%CI，1.5 至 3.8）与 48 小时时的死亡或机械通气相关。在 108 例无这些心电图异常且呼吸生命体征正常（呼吸频率<20 次/分且饱和度>95%）的患者中，只有 5 例（4.6%）在 48 小时内死亡或需要机械通气，而在 216 例同时存在心电图和呼吸生命体征异常的患者中，有 68 例（31.5%）出现这种情况。
异常呼吸生命体征与心电图发现的心房颤动/扑动、右心室应变或 ST 段异常相结合，可准确预测 2019 冠状病毒病患者的早期恶化，并可能有助于患者分诊。
