新型冠状病毒肺炎患者心电图P波振幅和ST-T异常对其病死率的预测价值

Predictive value of P wave amplitude and ST-T abnormalities in patients with COVID-19 on mortality

目的探究新型冠状病毒肺炎(COVID-19)患者心电图特征与其住院期间临床预后的关系,提高对高危患者的早期识别及干预能力,提高患者住院生存率。方法纳入2020年2月1日至4月30日在武汉协和医院西院住院确诊COVID-19并且至少有1份完整心电图的患者459例,根据患者住院期间是否发生死亡,分为死亡组及存活组,收集并分析患者的一般临床资料、实验室检查结果及一般心电图特征。结果①与存活组相比,死亡组多为男性(74.1%对44.1%),年龄较大(中位年龄:69.0岁对59.0岁),差异均具有统计学意义(P<0.01);死亡组伴有合并症比例更高,死亡组入院时心肌损伤标志物均显著升高(P<0.01)。②死亡组更容易出现ST-T异常(69.0%对38.2%,P<0.01),ST-T异常伴超敏肌钙蛋白Ⅰ(hs-TNI)升高的患者住院生存率显著下降(P<0.01)。③死亡组P波振幅更高[(1.28±0.38)mm对(1.02±0.38)mm,P<0.01],ΔP波振幅≥0 mm患者住院生存率显著下降(P<0.01)。④高P波振幅、ΔP波振幅≥0 mm以及ST-T异常是患者住院期间死亡的危险因素,OR值分别为4.32(95%CI 1.93~9.64,P<0.01)、12.95(95%CI 2.54~65.96,P<0.01)及3.10(95%CI 1.59~6.04,P<0.01)。结论2019新型冠状病毒(2019-nCoV)感染可引起广泛的心脏损伤,P波振幅增加、ΔP波振幅≥0 mm以及ST-T异常是预测死亡风险的重要因子。

Objective To explore the relationship between the electrocardiogram(ECG)characteristics of COVID-19 patients and their clinical prognosis during hospitalization,improve the early identification and intervention capabilities of high-risk patients,and improve the survival rate of patients.Methods A total of 459 patients with confirmed COVID-19 admitted to the West Hospital of Wuhan Union Hospital from February 1,2020 to April 30,2020 were included.They were divided into the death group and the survival group according to whether the patients died during their hospitalization.General clinical data,laboratory test results and general characteristics of the patients were collected and analyzed.Results①Compared with the survival group,the death group was mostly male and older(74.1%vs.44.1%;median age,69.0 vs.59.0 years old,P<0.01).The death group had higher rates of comorbidities and elevated markers of myocardial injury on admission(P<0.01).②The death group was more likely to have ST-T abnormalities(69.0%vs.38.2%,P<0.01),and the in-hospital survival rate of patients with abnormal ST-T and increased hypersensitive troponinⅠ(hs-TNI)was significantly lower(P<0.01).③The death group had a higher P wave amplitude[(1.28±0.38)mm vs.(1.02±0.38)mm,P<0.01],and hospitalization survival rate was significantly reduced in patients withΔP wave amplitude≥0 mm(P<0.01).④High P wave amplitude,ΔP wave amplitude≥0 mm,and ST-T abnormalities were risk factors for in-hospital death,with OR values of 4.32(95%CI 1.93-9.64,P<0.01),12.95(95%CI 2.54-65.96,P<0.01),and 3.10(95%CI 1.59-6.04,P<0.01),respectively.Conclusion 2019 novel coronavirus(2019-nCoV)infection can cause extensive heart damage,and increased P wave amplitude and ST-T abnormalities are important predictors of mortality risk.