The Combination of Chest Computed Tomography and Standard Electrocardiogram Provides Prognostic Information and Pathophysiological Insights in COVID-19 Pneumonia
Abstract
:1. Introduction
2. Methods
2.1. Study Setting and Patient Cohort
2.2. Data Collection
2.3. Outcome and Prognostic Endpoint
2.4. Statistical Analysis
3. Results
3.1. Patient Population
3.2. Chest CT and ECG Findings
3.3. Prognostic Analysis
4. Discussion
4.1. Pathophysiological Insights
4.2. Clinical Implications
5. Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
AUC | area under the curve |
BIC | Bayesian information criterion |
COVID-19 | coronavirus disease-2019 |
CT | computed tomography |
ECG | electrocardiogram/electrocardiographic |
HR | hazard ratio |
IQR | interquartile range |
RBBB | right bundle branch block |
RV | right ventricular |
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Overall (151) | Survivors (97) | Deceased (54) | p | |
---|---|---|---|---|
Male, no. (%) | 95 (63) | 62 (64) | 33 (61) | 0.73 |
Age, yrs (IQR) | 71 (62–76) | 69 (58–75) | 74 (65–79) | 0.006 |
Hypertension, no. (%) | 117 (77) | 75 (77) | 42 (78) | 1.00 |
Dyslipidemia, no. (%) | 27 (22) | 20 (27) | 7 (13) | 0.18 |
Cigarette smoking, no. (%) | 22 (18) | 15 (19) | 7 (13) | 0.63 |
Diabetes, no. (%) | 28 (19) | 20 (21) | 8 (15) | 0.51 |
History of atrial fibrillation/flutter, no. (%) | 24 (16) | 13 (13) | 11 (20) | 0.35 |
Cardiovascular disease, no. (%) | 16 (11) | 10 (10) | 6 (11) | 1.00 |
Previous heart disease, no. (%) | 14 (9) | 9 (9) | 5 (9) | 1.00 |
Previous coronary artery disease, no. (%) | 9 (6) | 4 (4) | 5 (9) | 0.28 |
Previous peripheral artery disease, no. (%) | 4 (3) | 2 (2) | 2 (4) | 0.62 |
Chronic kidney disease (eGFR <60 mL/min/m2), no. (%) | 36 (29) | 19 (25) | 17 (35) | 0.31 |
Chronic obstructive pulmonary disease, no. (%) | 30 (20) | 21 (22) | 9 (17) | 0.53 |
Active malignancy, no. (%) | 13 (9) | 7 (7) | 6 (11) | 0.55 |
Systolic blood pressure at hospital admission, mmHg (IQR) | 125 (100–150) | 135 (100–150) | 123 (100–145) | 0.37 |
Diastolic blood pressure at hospital admission, mmHg (IQR) | 75 (65–85) | 75 (65–85) | 75 (65–85) | 0.45 |
Oxygen saturation at hospital admission, % (IQR) | 90 (85–93) | 90 (86–93) | 89 (84–93) | 0.48 |
Vasopressor drugs at hospital admission, no (%) | 12 (7.9) | 6 (6.2) | 6 (11.1) | 0.35 |
Intensive care unit, no. (%) | 61 (40) | 49 (51) | 12 (22) | 0.001 |
Invasive ventilation, no. (%) | 54 (36) | 44 (45) | 10 (19) | 0.001 |
Non-invasive ventilation, no. (%) | 104 (69) | 68 (70) | 36 (67) | 0.72 |
Blood tests at hospital admission | ||||
Hemoglobin, g/dL (IQR) | 13.6 (12.3–14.8) | 13.5 (12.4–14.5) | 14.1 (12.2–15.0) | 0.59 |
D-dimer, mg/L (IQR) | 1.06 (0.70–1.95) | 1.00 (0.67–1.65) | 1.48 (0.90–2.46) | 0.008 |
LDH, U/L (IQR) | 393 (305–507) | 393 (395–535) | 391 (301–492) | 0.61 |
WBC, x103/μL (IQR) | 4.54 (3.52–6.12) | 4.54 (3.54–6.09) | 4.78 (3.40–6.29) | 0.99 |
CRP, mg/dL (IQR) | 10.6 (5.6–16.4) | 10.0 (5.1–14.2) | 13.1 (7.4–18.0) | 0.012 |
Medication during hospitalization | ||||
Heparin, no. (%) | 95 (77) | 61 (80) | 34 (71) | 0.28 |
Hydroxychloroquine, no. (%) | 107 (86) | 67 (88) | 40 (83) | 0.59 |
Antiviral drug, no. (%) | 103 (83) | 64 (84) | 39 (81) | 0.81 |
Tocilizumab, no. (%) | 7 (6) | 5 (7) | 2 (4) | 0.71 |
Steroids, no. (%) | 61 (40) | 39 (40) | 22 (41) | 0.71 |
Overall (151) | Survivors (97) | Deceased (54) | p | |
---|---|---|---|---|
Computed tomography scan | ||||
Pneumonia severity, no. (%) | 0.13 | |||
Mild | 46 (31) | 35 (36) | 11 (20) | |
Moderate | 80 (53) | 47 (48) | 33 (61) | |
Severe | 25 (17) | 15 (16) | 10 (19) | |
Moderate/severe pneumonia, no. (%) | 105 (70) | 62 (64) | 43 (80) | 0.044 |
Electrocardiogram | ||||
Abnormal electrocardiogram, no. (%): | 121 (80) | 74 (76) | 47 (87) | 0.13 |
Heart rate, bpm (IQR) | 82 (70–97) | 80 (68–95) | 85 (73–100) | 0.23 |
Atrial fibrillation/flutter, no. (%) | 15 (10) | 6 (6%) | 9 (17%) | 0.039 |
QRS interval, ms (SD) | 90 (80–100) | 90 (80–98) | 90 (80–110) | 0.47 |
Low QRS voltage peripheral leads, no. (%) | 4 (2.8) | 4 (4.3) | 0 (0.0) | 0.30 |
Pathologic Q waves, no. (%): | 10 (7) | 4 (4.1) | 6 (11.1) | 0.17 |
Left ventricular hypertrophy, no (%) | 9 (6) | 7 (7.2) | 2 (3.7) | |
S1Q3T3 pattern, no. (%) | 12 (8) | 5 (5) | 7 (13) | 0.089 |
RBBB, no. (%) | 25 (17) | 9 (9) | 16 (30) | 0.001 |
RV strain, no. (%) | 29 (19) | 10 (10) | 19 (35) | <0.001 |
Left anterior hemiblock, no. (%) | 9 (6) | 4 (4) | 5 (9) | 0.20 |
LBBB, no (%) | 4 (3) | 4 (4) | 0 (0) | 0.13 |
Non-specific RA, no. (%) | 33 (23) | 19 (21) | 14 (27) | 0.41 |
QTc, ms (IQR) | 445 (414–464) | 443 (415–460) | 448 (413–470) | 0.36 |
Univariable | Multivariable Backward Elimination (FULL MODEL) | |||||
---|---|---|---|---|---|---|
HR | 95ci | p | HR | 95ci | p | |
Sex | 0.908 | 0.525–1.569 | 0.729 | |||
Age | 1.647 | 1.139–2.381 | 0.008 | 1.484 | 1.032–2.133 | 0.0311 |
LDH | 1.061 | 0.728–1.546 | 0.758 | |||
WBC | 1.125 | 0.902–1.405 | 0.296 | |||
CRP | 1.359 | 0.907–2.036 | 0.137 | 1.46 | 0.96–2.219 | 0.0766 |
D-dimer peak | 1.335 | 1.051–1.697 | 0.018 | |||
Oxygen saturation | 0.83 | 0.595–1.158 | 0.273 | |||
Non-severe pneumonia | 1.956 | 0.988–3.872 | 0.054 | |||
Severe pneumonia | 2.596 | 1.075–6.266 | 0.034 | 2.043 | 0.835–5 | 0.12 |
ECG signs of acute RV strain | 3.094 | 1.762–5.431 | <0.001 | 2.464 | 1.364–4.451 | 0.0028 |
Comorbidity | 0.977 | 0.788–1.211 | 0.829 |
Loglik | Chisq | p(>|Chi|) | BIC | |
---|---|---|---|---|
Age + CRP + pneumonia severity + RV strain | −246.767 | 517.458 | ||
Age + CRP + pneumonia severity | −250.835 | 8.166 | 0.004 | 521.615 |
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Bertini, M.; D’Aniello, E.; Cereda, A.; Toselli, M.; Verardi, F.M.; Rossi, L.; Aschieri, D.; Monello, A.; Manfrini, M.; Vignale, D.; et al. The Combination of Chest Computed Tomography and Standard Electrocardiogram Provides Prognostic Information and Pathophysiological Insights in COVID-19 Pneumonia. J. Clin. Med. 2021, 10, 3031. https://doi.org/10.3390/jcm10143031
Bertini M, D’Aniello E, Cereda A, Toselli M, Verardi FM, Rossi L, Aschieri D, Monello A, Manfrini M, Vignale D, et al. The Combination of Chest Computed Tomography and Standard Electrocardiogram Provides Prognostic Information and Pathophysiological Insights in COVID-19 Pneumonia. Journal of Clinical Medicine. 2021; 10(14):3031. https://doi.org/10.3390/jcm10143031
Chicago/Turabian StyleBertini, Matteo, Emanuele D’Aniello, Alberto Cereda, Marco Toselli, Filippo Maria Verardi, Luca Rossi, Daniela Aschieri, Alberto Monello, Marco Manfrini, Davide Vignale, and et al. 2021. "The Combination of Chest Computed Tomography and Standard Electrocardiogram Provides Prognostic Information and Pathophysiological Insights in COVID-19 Pneumonia" Journal of Clinical Medicine 10, no. 14: 3031. https://doi.org/10.3390/jcm10143031