Hubungan Gambaran EKG pads Pasien COVID-19 Dengan Mortalitas Selama Rawatan Di RSUP H. Adam Malik Medan

Abstract

Background: Coronavirus disease 2019 (COVID-19) is new global pandemic affected not only respiratory but also cardiovasvular system. The need of simple tool such as ECG to determine prognostic factor in this disease is substantial. Methods: We performed retrospective cohort study based on medical record from COVID-19 patient who admitted to Haji Adam Malik General Hospital. Multivariate analysis was performed to evaluate procnostic value of ECG for inhospital mortality of COVID-19 patients. Result: We evaluate 143 pateints of COVID-19 who underwent ECG between June and Agust 2021. Eighty two (57.3%) of them has abnormal ECG finding. The results of the bivariate test showed that the ECG which had a significant relationship with in-hospital mortality were sinus tachycardia p value = 0.005 (OR: 3,569; 1,523 – 8,364), QRS rate > 100 bpm, p <0.001, QRS duration ≥ 110 ms p=0.005 (OR: 10,577; 1,943 – 57,586), RBBB p=0.02 (OR: 8,148; 1,418 - 46,833) T-Inversion wave p=0.028 (OR 2,864; 95% CI: 1,199 – 6.841), pathological Q-wave p=0.012 (OR: 6.987; 95% CI 1.569 – 31), presence or absence of ECG abnormalities p=<0.001 (OR: 6.995; 95% CI: 2.297 – 21.301), 3 ECG abnormalities p<0.001 (OR: 10,833; 3,806 – 30,837). In multivariate analysis, two ECG parameters that have significant value: QRS rate > 100 bpm, p = 0.029 (OR: 3.467 95% CI: 1.135 – 10.593), ECG abnormalities ≥ 3, p=0.015 (OR: 5.177; 95% CI: 1.380 – 19.415). Conclusion: ECG can be useful for prognostic assessment of COVID-19 patients. QRS rate >100 bpm and ≥ 3 abnormalities of ECG are independent factors for inhospital mortality based on multivariate analysis.

Latar Belakang: Coronavirus disease 2019 (COVID-19) merupakan pandemi global baru yang berdampak tidak hanya pada sistem pernapasan tetapi juga sistem kardiovaskular. Kebutuhan alat sederhana seperti EKG untuk menentukan faktor prognostik pada penyakit ini cukup besar. Metode: Kami melakukan studi kohort retrospektif berdasarkan rekam medis pasien COVID-19 yang dirawat di Rumah Sakit Umum Haji Adam Malik. Analisis multivariat dilakukan untuk mengevaluasi nilai procnostik EKG untuk mortalitas pasien COVID-19 di rumah sakit. Hasil: Kami mengevaluasi 143 pasien COVID-19 yang menjalani EKG antara Juni dan Agustus 2021. Delapan puluh dua (57,3%) di antaranya memiliki temuan EKG abnormal. Hasil uji bivariat menunjukkan bahwa EKG yang memiliki hubungan signifikan dengan mortalitas di rumah sakit adalah sinus takikardia p value = 0,005 (OR: 3,569; 1,523 – 8,364), laju QRS > 100 kali/menit, p <0,001, durasi QRS 110 ms p=0.005 (OR: 10.577; 1.943 – 57.586), RBBB p=0.02 (OR: 8.148; 1.418 - 46.833) Gelombang T-Inversion p=0.028 (OR 2.864; 95% CI: 1.199 – 6.841), gelombang Q patologis p=0,012 (OR: 6,987; 95% CI 1,569 – 31), ada tidaknya abnormalitas EKG p=<0,001 (OR: 6,995; 95% CI: 2,297 – 21,301), abnormalitas EKG ≥3, p<0,001 (OR: 10.833; 3.806 – 30.837). Pada analisis multivariat, dua parameter EKG yang memiliki nilai signifikan: laju QRS > 100 kali/menit, p = 0,029 (OR: 3,467 95% CI: 1,135 – 10,593), abnormalitas EKG ≥3, p=0,015 (OR: 5,177; 95% CI : 1.380 – 19.415). Kesimpulan: EKG dapat bermanfaat untuk penilaian prognostik pasien COVID- 19. Laju QRS >100 bpm dan abnormalitas EKG ≥3 merupakan faktor independen untuk mortalitas di rumah sakit berdasarkan analisis multivariat