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Electrocardiogram abnormalities and higher body mass index as clinically applicable factors for predicting poor outcome in patients with coronavirus disease 2019
doi: 10.2478/fzm-2022-0032
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Abstract:
Background Patients with coronavirus disease 2019 (COVID-19) have high resource utilization. Identifying the causes of severe COVID-19 is helpful for early intervention to reduce the consumption of medical resources. Methods We included 103 patients with COVID-19 in this single-center observational study. To evaluate the incidence, predictors, and effects of COVID-19, we analyzed demographic information, laboratory results, comorbidities, and vital signs as factors for association with severe COVID-19. Results The incidence of severe COVID-19 was 16.5% and the percent poor outcome (including mortality, entering in ICU or transferred to a superior hospital) was 6.8%. The majority of severe COVID-19 patients had abnormal electrocardiogram (ECG) (82.35%), hypertension (76.47%) and other cardiac diseases (58.82%). Multivariate logistic regression was used to determine the predictors of severe illness. Abnormal body mass index (BMI) and ECG (P < 0.05) were independent predictors of severe COVID-19. ECG abnormality was associated with increased odds of poor outcome (area under the receiver operating characteristic curves [AUC], 0.793; P = 0.010) and severe COVID-19 (AUC, 0.807; P < 0.0001). Overweight was also associated with increased odds of poor outcome (AUC, 0.728; P = 0.045) and severe illness COVID-19 (AUC, 0.816; P < 0.0001). Conclusion Overweight and electrophysiological disorders on admission are important predictors of prognosis of patients with COVID-19. -
Key words:
- electrocardiogram abnormalities /
- overweight /
- coronavirus disease 2019
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Figure 1. AUCs for severe ill COVID-19 (A), poor outcome (B) and medical costs > 14 671.88 Chinese yuan (C) for ECG abnormalities and body-mass index AUC, area under the receiver operating characteristic curves; BMI, body mass index; COVID-19, coronavirus disease 2019; ECG, electrocardiogram.
Figure 2. Survival curves of ECG abnormalities (A) and body-mass index (B) BMI, body-mass index; ECG, electrocardiogram.
Table 1. The demographics and clinical characteristics of 103 patients with COVID-19
Demography and clinical characteristic Value Age, years 50.40 ± 15.87 Sex, n (%) Male 50(48.5) Female 53(51.5) Body mass index, kg/m2 24.6 ± 3.68 Comorbiditiesa (n = 47), n (%) Hypertension 34(33.0) Diabetes mellitus 12(11.7) Cardiovascular diseases 22(21.4) Nervous system diseases 2 (1.9) Respiratory diseases 2 (1.9) Others 9 (8.7) ECG abnormalities, n (%) 32(31.1) Symptoms on admission, n (%) Fever 81(77.88) Cough 63(60.58) Myalgias 42(40.38) Diarrhea 17(16.34) Upper airway congestion 44(42.31) Presentation values White blood cell count, ×109/L 5.38 ± 2.90 Lymphocyte count, ×109/L 1.29 ± 0.57 Lymphocyte percentage, % 25.76 ± 10.91 Alanine aminotransferase, U/L 35.74 ± 87.88 Aspartate aminotransferase, U/L 39.57 ± 124.10 Blood urea nitrogen, mmol/L 4.13 ± 3.71 Creatinine, μmol/L 69.42 ± 128.75 Cystatin C, mg/L 1.03 ± 0.97 Creatine Kinase, U/L 151.15 ± 435.97 Creatine Kinase MB Form, U/L 15.59 ± 21.65 C-reactive protein, mg/L 16.99 ± 19.75 Treatment, n (%) Single antiviral agent 58(56.3) Combined antiviral agents 23(22.3) Developing Severe COVID-19, n (%) 17(16.5) Poor outcome, n (%)b 7 (6.8) Total medical costs, Chinese yuan 14671.88 a, More than one comorbidity was reported for some patients; b, Mortality, ICU admission or transfer to a superior hospital; ECG, electrocardiogram; COVID-19, coronavirus disease 2019. 
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Table 2. Comparisons of risk factors of cardiovascular disease in patients with severe and non-severe COVID-19
Item Non-severe (n = 89) Severe (n = 14) P value Median body mass index, kg/m2* 23.86± 2.96 28.36 ± 4.68 < 0.0001 Comorbidities, n (%) Hypertension 21 (24.42) 13 (76.47) < 0.0001 Diabetes mellitus 7 (8.14) 5 (29.41) 0.013 Cardiovascular diseases 12 (13.95) 10 (58.82) < 0.0001 ECG, n (%) < 0.0001 Normal 68 (79.07) 3 (17.65) Abnormal 18 (20.93) 14 (82.35) Myocardial enzymes* Aspartate aminotransferase, U/L 26.47 ± 9.51 105.94 ± 303.48 0.296 Creatine Kinase, U/L 95.44 ± 72.31 432.94 ± 1040.61 0.200 Creatine Kinase MB Form, U/L 12.47 ± 4.90 31.41 ± 50.41 0.141 *, values are mean ± SD; COVID-19, coronavirus disease 2019; ECG, electrocardiogram.
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Table 3. Univariate logistic regression evaluating potential predictors of severe COVID-19
Variable OR 95% CI P Value Age, years 1.050 1.012-1.090 0.009 Sex Male Ref. — — Female 0.931 0.328-2.640 0.893 Median body mass index, kg/m2 1.445 1.178-1.772 0.0004 Comorbidities Hypertension 10.060 2.958-34.206 0.0002 Diabetes mellitus 4.702 1.284-17.227 0.019 Cardiovascular diseases 8.810 2.811-27.610 0.0002 Nervous system diseases — — — Respiratory diseases — — — Others 1.505 0.285-7.958 0.631 ECG abnormalities 17.630 4.566-68.062 < 0.0001 Laboratory test results on admission White blood cell count, ×109/L 1.353 1.055-1.734 0.017 Lymphocyte count, ×109/L 0.084 0.018-0.399 0.002 Lymphocyte percentage, % 0.882 0.823-0.945 0.0004 Alanine aminotransferase, U/L 1.005 0.996-1.013 0.264 Aspartate aminotransferase, U/L 1.033 0.994-1.073 0.096 Blood urea nitrogen, mmol/L 1.492 1.043-2.136 0.029 Creatinine, μmol/L 1.018 0.995-1.043 0.129 Creatine kinase, U/L 1.005 1.000-1.010 0.073 Creatine kinase MB Form, U/L 1.114 1.005-1.236 0.041 C-reactive protein, mg/L 1.060 1.027-1.094 0.0003 Treatment Single antiviral agent Ref. — — Combined antiviral agents 2.423 0.512-11.477 0.265 ECG, electrocardiogram; OR, odds ratio; CI, confidence interval.
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Table 4. Multivariate logistic regression evaluating potential predictors of developing severe COVID-19
Variable OR 95% CI P Value Age, years 1.110 0.969-1.273 0.133 Median body mass index, kg/m2 2.972 1.037-8.519 0.043 Comorbidities Hypertension 5.137 0.119-222.528 0.395 Cardiovascular disease 1.347 0.009-211.636 0.908 ECG abnormalities 52.695 1.709-1624.474 0.023 Laboratory test results on admission Lymphocyte count, ×109/L 3.685 0.032-418.741 0.589 Lymphocyte percentage, % 0.674 0.435-1.046 0.079 C-reactive protein, mg/L 1.040 0.957-1.131 0.358 ECG, electrocardiogram; OR, odds ratio; CI, confidence interval.
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