Does coexistence of fragmented QRS and cardiovascular disease have the ability to predict the mortality in hospitalized, critically ill patients with COVID-19?

Objective: In this study, we aimed to investigate the prognostic accuracy of the presence of fragmented QRS (fQRS) on baseline electrocardiogram on the adverse outcome in critical patients with coronavirus disease 2019 (COVID-19) with cardiovascular disease (CVD). Methods: The current study was retrospective designed and included 169 patients who were critically ill with COVID-19 and CVD (mean age of 62 +/- 15 years). The patients were grouped into those who died (non-survivor group) and those who survived (survivor group). Results: The non-survivors were older and more often had CVD (p=0.009), hypertension (p=0.046), diabetes (p=0.048), cancer (p=0.023), and chronic renal failure (p=0.001). Although the presence of fQRS on the basal electrocardiogram was more common in patients who died, this was not statistically significant (p=0.059). Furthermore, non-survivors had more frequent the coexistence of CVD and fQRS (p=0.029). In Model 1 multivariate regression analysis, CVD alone was not a predictor of mortality (p=0.078), whereas coexistence of CVD and fQRS was found to be an independent predictor of mortality in Model 2 analysis [hazard ratio (HR): 2.243; p=0.003]. Furthermore, older age (HR: 1.022; p=0.006 and HR: 1.023; p=0.005), cancer (HR: 1.912; p=0.021 and HR: 1.858; p=0.031), high SOFA score (HR: 1.177; p=0.003 and HR: 1.215; p<0.001), and increased CRP level (HR: 1.003; p=0.039 and HR: 1.003; p=0.027) independently predicted the mortality in both multivariate analysis models, respectively. Conclusion: fQRS may be a useful and handy risk-stratification tool for clinical outcomes by identifying high-risk individuals, especially among those with CVD.

Automated summary

In critical COVID-19 patients with cardiovascular disease, older age and comorbidities such as cancer, hypertension, diabetes, and chronic renal failure were associated with increased mortality risk. While the presence of fQRS on baseline ECG was not statistically significant, the coexistence of cardiovascular disease and fQRS independently predicted mortality. Additionally, other factors such as high SOFA score and increased CRP level were also predictive of mortality. This suggests that fQRS could be a valuable tool for risk stratification in identifying high-risk individuals, particularly in patients with cardiovascular disease.