The Association of Fragmented QRS with Outcomes in Elderly Medical ICU Patients

Objective: The study was conducted to assess the relationship between QRS fragmentation identified by a 12 lead electrocardiogram and outcomes in elderly medical intensive care unit (ICU) patients. Methods: The patients 65 years and older were retrospectively investigated. The patients were divided into two groups according to the presence of QRS fragmentation (fQRS). Findings were compared between two groups. In addition, ICU survivors and non-survivors were compared to identify the factors affecting ICU mortality. Results: fQRS presence was more frequent in patients with underlying hypertension and coronary artery disease (60% vs. 27%, p=0.01, and 29% vs 7%, p=0.05, respectively). Patients with fQRS had higher APACHE II scores (26.3 & PLUSMN;8 vs 22.5 & PLUSMN;7.3, p=0.01). C-reactive protein (CRP) and procalcitonin levels were higher in patients with fQRS (100[57-220] vs. 25[12-54] and 2[0.5-4.75] vs. 0.2[0.7-1], respectively, p<0.01). QRS fragmentation was more frequent in ICU non-survivors than survivors (22(61%) vs 13(22%), p<0.01). ICU non-survivors had higher APACHE-II and SOFA scores than survivors (29.9 & PLUSMN;6.6 vs. 0.2 & PLUSMN;5.9 and 10[7-16] vs 6[3-9], respectively, p<0.01). Requirement of invasive mechanical ventilation, APACHE-II, and SOFA Score on ICU admission were independently associated with ICU mortality (OR(95%CI): 22(2.7-147), p=0.01 and 1.28(1.04-1.59), p=0.02 and 1.10(1.01-1.19), p=0.03, respectively). Conclusion: The fQRS has a significant potential to be a prognostic marker in specific non-cardiac ICU patient populations.