Optimization of the system for predicting the severity of the course of COVID-19 in hospitalizedpatients based on cardiovascular history, initial clinical status and surface ECG indicators
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https://orcid.org/0000-0002-1427-2344
Abstract
The aim – to optimize the system of early assessment of the tendency to a more severe subsequent course of COVID-19, based on initial clinical, anamnestic and electrocardiographic markers.
Materials and methods. Data from primary medical documentation on 104 patients with moderate severity of COVID-19 (50 men and 54 women, aged 24 to 84 years) who were treated (at least 16 days) in clinics of Ukraine during 2020–2021 were analyzed on the study of the effectiveness of the treatment of COVID-19. Risk factors (advanced age, inflammatory diseases, cardiovascular pathology: the presence of hypertension, obesity, diabetes, coronary artery disease, heart failure (HF), persistent or permanent atrial fibrillation (AF)), dynamics of the clinical state (HR, to body, blood pressure, SpO2, respiratory rate (HR), clinical symptoms and signs from all body systems), as well as surface ECG data in 12 leads were studied. Based on the dynamics of the clinical condition (according to a specially developed scale), all patients were divided into group A (66 pts, a more severe hospital course of COVID-19) and group B (38 pts, a milder variant of the course of COVID-19).
Results and discussion. Among the electrocardiographic risk factors (RF) of a more severe hospital course of moderate-severe COVID-19, the following were more informative than others: a decrease in the amplitude of the Q wave in lead V5 (HR = 1.96 (95 % CI 1.29–2.96)) and an increase in the amplitude of the S wave in lead V4 (HR = 1.57 (95 % CI 1.18–2.08)), an increase in the duration of the QR interval in lead V1 (HR = 1.49 (95 % CI 1.11–2.0)) and its decrease – in leads V5–V6 (HR = 1.64 (95 % CI 1.3–2.1)), ST segment elevation in lead V4 (HR = 1.69 (95 % CI 1.43–2.00)), a low-amplitude T wave in lead I (HR = 1.60 (95 % CI 1.15–2.23)) and the appearance of abnormal TU complexes in leads V2–V6 (HR = 1.37 (95 % CI 1.04–1.80)), as well as a model built taking into account 8 ECG criteria (duration of the QR interval in lead V1 > 20 ms and in lead V5 < 24 ms, SI wave amplitude ratio to QII wave amplitude ratio > 4, R wave amplitude ratio in avL to QV5 wave amplitude ratio > 16, QR interval duration ratio in V1 to QR interval duration in V5 > 1, the ratio of ST elevation in V4 to the amplitude of the TI wave > 1), evaluated according to their significance (area under the ROC curve (ROC) 0.88, for values > 35 points HR = 2.43 (1.73–3.39)). When the 8-component ECG scale was combined with the components of the previously created clinical and anamnestic scales, the ROC increased to 0.93, the value > 48 points on the first day of COVID-19 with a sensitivity of 86 % and a specificity of 87 % (HR = 4.29 (2,4–7,69)) predicted a more severe variant of the hospital course of COVID-19 of moderate severity.
Conclusions. The developed and optimized risk assessment system, based on clinical, anamnestic and electrocardiographic data, allows to accurately predict the subsequent more severe course of the disease on the first day of treatment for COVID-19. These results are promising from a practical point of view and require further study in a prospective study.
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References
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