Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden.
Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden.
PLoS One. 2021 Dec 14;16(12):e0261315. doi: 10.1371/journal.pone.0261315. eCollection 2021.
We investigated the prevalence of ECG abnormalities and their association with mortality, organ dysfunction and cardiac biomarkers in a cohort of COVID-19 patients admitted to the intensive care unit (ICU).
This cohort study included patients with COVID-19 admitted to the ICU of a tertiary hospital in Sweden. ECG, clinical data and laboratory findings during ICU stay were extracted from medical records and ECGs obtained near ICU admission were reviewed by two independent physicians.
Eighty patients had an acceptable ECG near ICU-admission. In the entire cohort 30-day mortality was 28%. Compared to patients with normal ECG, among whom 30-day mortality was 16%, patients with ECG fulfilling criteria for prior myocardial infarction had higher mortality, 63%, odds ratio (OR) 9.61 (95% confidence interval (CI) 2.02-55.6) adjusted for Simplified Acute Physiology Score 3 and patients with ST-T abnormalities had 50% mortality and OR 6.05 (95% CI 1.82-21.3) in univariable analysis. Both prior myocardial infarction pattern and ST-T pathology were associated with need for vasoactive treatment and higher peak plasma levels of troponin-I, NT-pro-BNP (N-terminal pro-Brain Natriuretic Peptide), and lactate during ICU stay compared to patients with normal ECG.
ECG with prior myocardial infarction pattern or acute ST-T pathology at ICU admission is associated with death, need for vasoactive treatment and higher levels of biomarkers of cardiac damage and strain in severely ill COVID-19 patients, and should alert clinicians to a poor prognosis.
我们研究了在入住重症监护病房（ICU）的 COVID-19 患者队列中，心电图异常的发生率及其与死亡率、器官功能障碍和心脏生物标志物的关系。
这项队列研究纳入了瑞典一家三级医院 ICU 收治的 COVID-19 患者。从病历中提取 ICU 期间的心电图、临床数据和实验室检查结果，并由两名独立医生对 ICU 入院附近获得的心电图进行复查。
80 名患者在 ICU 入院附近获得了可接受的心电图。在整个队列中，30 天死亡率为 28%。与心电图正常的患者相比，其中 30 天死亡率为 16%，心电图符合陈旧性心肌梗死标准的患者死亡率更高，为 63%，比值比（OR）为 9.61（95%置信区间（CI）为 2.02-55.6），校正简化急性生理学评分 3 后；心电图存在 ST-T 异常的患者 30 天死亡率为 50%，OR 为 6.05（95%CI 为 1.82-21.3）。陈旧性心肌梗死模式和 ST-T 病理与需要血管活性治疗以及 ICU 期间肌钙蛋白 I、NT-pro-BNP（N 端脑利钠肽前体）和乳酸的峰值血浆水平升高相关，与心电图正常的患者相比。
入住 ICU 时心电图存在陈旧性心肌梗死模式或急性 ST-T 病理与死亡、需要血管活性治疗以及心脏损伤和应激生物标志物水平升高相关，提示临床医生预后不良。
