Newly discovered biomarker predicts COVID-19 death days in advance

Newly discovered biomarker pre...
A drop in certain heart electrical activity readings was found to precede COVID-19 death by around 52 hours
A drop in certain heart electrical activity readings was found to precede COVID-19 death by around 52 hours
View 1 Image
A drop in certain heart electrical activity readings was found to precede COVID-19 death by around 52 hours
A drop in certain heart electrical activity readings was found to precede COVID-19 death by around 52 hours

Researchers from The Mount Sinai Hospital have found changes to electrical activity in the heart can help predict which hospitalized COVID-19 patients are more likely to decline and die. The biomarker is easily measurable and potentially predicts death several days in advance.

When hospitals are overwhelmed with COVID-19 patients it can be challenging for doctors to work out where to best focus their limited attention and resources. A number of blood-based biomarkers have been found to help assess those patients most at risk of severe disease decline.

But blood tests take time to be collected and analyzed. This new biomarker can be measured using a simple electrocardiogram (EKG) machine, at a patient’s bedside. And the researchers claim it can predict whether a patient is likely to die at least two days in advance.

A retrospective investigation of health records from 140 COVID-19 patients revealed diminishing QRS waveforms were an indication of a patient declining in 74 percent of cases.

The criteria developed by the Mount Sinai team is dubbed LoQRS, and they propose it to be an effective way of triaging those patients most likely to decline. The median time to death from the first LoQRS reading detected in the study was 52 hours.

“Our study shows diminished waveforms on EKGs over the course of COVID-19 illness can be an important tool for health care workers caring for these patients, allowing them to catch rapid clinical changes over their hospital stay and intervene more quickly,” says Joshua Lampert, senior author on the new study. “With COVID-19 cases and hospitalizations continuing to rise again, EKGs may be helpful for hospitals to use when caring for these patients before their condition gets dramatically worse.”

Interestingly, the researchers also found LoQRS measures were effective in detecting those patients with influenza who were most likely to die. The median time to death from the first LoQRS measure in influenza patients, however, was around six days. The researchers point out this indicates COVID-19 is a much more virulent disease than influenza.

As LoQRS measures can only be detected over time across several EKG tests, Lambert proposes EKG measurements are taken for all COVID-19 patients when they are initially admitted.

“When it comes to caring for COVID-19 patients, our findings suggest it may be beneficial not only for health care providers to check an EKG when the patient first arrives at the hospital, but also follow-up EKGs during their hospital stay to assess for LoQRS, particularly if the patient has not made profound clinical progress,” says Lampert. “If LoQRS is present, the team may want to consider escalating medical therapy or transferring the patient to a highly monitored setting such as an intensive care unit (ICU) in anticipation of declining health.”

The new study was published in the American Journal of Cardiology.

Source: Mount Sinai

Low voltage on an EKG is a common finding with end stage pulmonary patients, like COPD. This is just what you would expect to see in end stage COVID patients who are dying of extreme pulmonary complications. And this is a late finding so there is nothing you can do about it, except for ECMO maybe.
So here's the question: in a disaster-standards situation (which some/many hospitals in high-transmission areas are in) do you redouble your efforts on those patients, or do you just switch to palliative care? (And once you do switch to palliative care, you make the prediction self-confirming, so further study becomes very difficult.)
In the limited health resource situation of the non-vaccinated States, this LoQRS finding will likely lead to: a) increased honesty with patient family and increased emphasis on palliative care; b) awareness of the need for experimental therapies in an attempt to reverse the decreased cardiac electrical potentials. Medicine works best when all the options are available. Still - you have a 25% risk trying experimental therapies - what if you push the 25% who would recover further into cardiac electrical failure? There have to be some metabolic & anti-inflammatory aspects to the LoQRS that can be mitigated through innovative therapies. And Paul314: No, in vaccinated states where we are overwhelmed too, we do not engage in preprogrammed therapies to insure predictions come true. Evidence based medicine is based on percentages and a 25% recovery rate is established with this research. That leaves the metabolic and electrophysiology researchers in the forefront. In most ICU meetings, we do not switch to palliative care and say "Oh well". When that point of "it is up to God now" occurs, we continue supportive and palliative care as patient recovery and patient comfort remain the end goals. No, we discuss the options with the care team and ask for suggestions. We discuss the findings with other specialists and ask for options. Nothing outside of the layperson's opinion is written in stone. Remember - until this pandemic, SARS was practically a death sentence when it occurred. Through the medical - not layperson's - mindset we have developed anti-globulin therapies, vaccines, and the latest, an oral mitigating medication which I haven't seen used yet. There are smarter people than I who keep coming up with new lines of inquiry instead of throwing up their hands and saying "Oh well, the handwriting is on the wall". So no, this is NOT the time for such a cynical "Here's the Question". At least not in Medicine.
Nice write up Rich. We have seen that in the ICUs but had no data on when it started and what the outcome of the LoQRS would be. We see it with pulmonary edema (like in a pneumonia) with mediastinal effusions (among other physiological changes), with chronic morbid obesity, and with metabolic dysfunctions. We don't always see a predictable LoQRS in viral cardiomyopathy, although the reference to Takotsubo syndrome has been an essential read since the mid 2010's. Myocardial edema is implicated in Takotsubo syndrome, clearly SARS is capable of viral myocarditis and edema. We'll see what Merck's new drug can do - and compare survival statistics of the vaccinated, the unvaccinated, and both cohorts once viral myocarditis symptoms appear.