Electrocardiography on admission is associated with poor outcomes in coronavirus disease 2019 (COVID‐19) patients: A systematic review and meta‐analysis

• Published in: Journal of arrhythmia Vol. 37; no. 4; pp. 877 - 885
• Main Authors: Alsagaff, Mochamad Yusuf, Oktaviono, Yudi Her, Dharmadjati, Budi Baktijasa, Lefi, Achmad, Al‐Farabi, Makhyan Jibril, Gandi, Parama, Marsudi, Bagas Adhimurda, Azmi, Yusuf
• Format: Journal Article
• Language: English
• Published: Japan John Wiley & Sons, Inc 01.08.2021; John Wiley and Sons Inc; Wiley
• Subjects: Analysis; Clinical Review; Coronaviruses; COVID-19; Electrocardiogram; Electrocardiography; ICU admission; Meta-analysis; Mortality; Patient outcomes; Prognosis; Severe acute respiratory syndrome; severe illness; mortality; electrocardiogram; COVID‐19; severe illness; ICU admission
• ISSN: 1880-4276; 1883-2148
• DOI: 10.1002/joa3.12573

Background Electrocardiogram (ECG) is a widely accessible diagnostic tool that can easily be obtained on admission and can reduce excessive contact with coronavirus disease 2019 (COVID‐19) patients. A systematic review and meta‐analysis were performed to evaluate the latest evidence on the association of ECG on admission and the poor outcomes in COVID‐19. Methods A literature search was conducted on online databases for observational studies evaluating ECG parameters and composite poor outcomes comprising ICU admission, severe illness, and mortality in COVID‐19 patients. Results A total of 2,539 patients from seven studies were included in this analysis. Pooled analysis showed that a longer corrected QT (QTc) interval and more frequent prolonged QTc interval were associated with composite poor outcome ([WMD 6.04 [2.62‐9.45], P = .001; I2:0%] and [RR 1.89 [1.52‐2.36], P < .001; I2:17%], respectively). Patients with poor outcome had a longer QRS duration and a faster heart rate compared with patients with good outcome ([WMD 2.03 [0.20‐3.87], P = .030; I2:46.1%] and [WMD 5.96 [0.96‐10.95], P = .019; I2:55.9%], respectively). The incidence of left bundle branch block (LBBB), premature atrial contraction (PAC), and premature ventricular contraction (PVC) were higher in patients with poor outcome ([RR 2.55 [1.19‐5.47], P = .016; I2:65.9%]; [RR 1.94 [1.32‐2.86], P = .001; I2:62.8%]; and [RR 1.84 [1.075‐3.17], P = .026; I2:70.6%], respectively). T‐wave inversion and ST‐depression were more frequent in patients with poor outcome ([RR 1.68 [1.31‐2.15], P < .001; I2:14.3%] and [RR 1.61 [1.31‐2.00], P < .001; I2:49.5%], respectively). Conclusion Most ECG abnormalities on admission are significantly associated with an increased composite poor outcome in patients with COVID‐19. Electrocardiography abnormalities on admission, including longer QTc interval and prolonged QTc interval, longer QRS duration, a faster heart rate, the presence of LBBB, PAC, PVC, T‐wave inversion, and ST‐depression are significantly associated with an increased composite poor outcome in patients with COVID‐19.