• Pierre Elias, Timothy J Poterucha, Sneha S Jain, Gabriel Sayer, Jayant Raikhelkar, Justin Fried, Kevin Clerkin, Jan Griffin, Ersilia M DeFilippis, Aakriti Gupta, Matthew Lawlor, Mahesh Madhavan, Hannah Rosenblum, Zachary B Roth, Karthik Natarajan, George Hripcsak, Adler Perotte, Elaine Y Wan, Amardeep Saluja, Jose Dizon, Frederick Ehlert, John P Morrow, Hirad Yarmohammadi, Deepa Kumaraiah, Bjorn Redfors, Nicholas Gavin, Ajay Kirtane, Leroy Rabbani, Dan Burkhoff, Jeffrey Moses, Allan Schwartz, Martin Leon, and Nir Uriel.
• 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.
• Mayo Clin. Proc. 2020 Oct 1; 95 (10): 2099-2109.

ObjectiveTo study whether combining vital signs and electrocardiogram (ECG) analysis can improve early prognostication.MethodsThis 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.ResultsAt 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.ConclusionThe 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.Copyright © 2020 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

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