ANALYSIS OF ADMISSION ELECTROCARDIOGRAMS (EKGS) OF HOSPITALIZED COVID-19 PATIENTS THAT DEVELOPED SHOCK

Background

Severe Acute Respiratory Syndrome Coronavirus-2 causes COVID-19 and can have a significant effect on cardiovascular function even leading to shock. The electrocardiogram (EKG) is usually the first cardiovascular assessment and could be used to risk stratify admitted patients.

Methods

Between March and May 2020, we had 215 hospitalized COVID-19 patients who developed shock (hypotension requiring pressors), 150 of whom had an admission EKG. We used univariate and multivariable logistic regression that included age, manually adjudicated EKG abnormalities, and clinical characteristics to look for predictors of the adverse outcomes of intubation, death, and prolonged length of stay (LOS)>14 days.

Results

The median age was 66 years, with primarily men (65.8%) and non-white (63.3%) patients. EKG abnormalities were: 35.3% abnormal atrial rhythm [defined as other than normal sinus 60-100 bpm] (27.3 % sinus tachycardia >100bpm, 2.67% sinus bradycardia < 50bpm, 7.43% atrial fibrillation), abnormal T waves 17.9%, abnormal axis 21.34%, low voltage 15.99%, high voltage 7.33%, poor R wave progression 30.7%, Q waves 15.3%, and presence of atrial and ventricular premature beats (11.33% and 6% respectively). Our cohort had very poor outcomes with 97.3 % intubation, 80 % mortality, and 56% with prolonged LOS. Univariate analysis revealed no EKGs parameters that predicted adverse outcomes. This is partially explained by the high occurrence of the first 2 endpoints. For the third endpoint (LOS>14 days), the patients that survived had more prolonged hospitalizations. Using multivariate logistic regression, we found that older age and male gender were associated with increased mortality, while LOS and duration of ventilation had a protective effect against mortality (p-value = 0.05).

Conclusion

Despite the very high mortality observed in these COVID patients with shock, the admission EKGs have relatively minor abnormalities. We did not find any EKG parameter that was associated with the adverse outcomes of intubation, death, or prolonged LOS. Further study of the progression of EKG changes during hospitalization may provide additional insight into predicting poor prognosis.