Retrospective evaluation of laboratory, electrocardiography and imaging findings of copd patients admitted to Süleyman Demirel University emergency department with shortness of breath

Objective: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally, with its associated mortality and morbidity rates on the rise. Exacerbations constitute the primary reason for emergency department visits among COPD patients. This study was designed to assess the prognostic and mortality implications of electrocardiography (ECG) parameters and laboratory findings, given their rapid, accessible, and practical application in emergency settings. Methods: This retrospective, single-center study analyzed the medical records of 202 patients diagnosed with COPD exacerbation, who were admitted to the Emergency Department of Süleyman Demirel University Medical Faculty Hospital between November 1, 2022, and November 1, 2023. Patients with complete data were included in the study. Demographic information, vital signs, laboratory findings, ECG parameters, and posteroanterior chest X-ray (PAAC) results were recorded. Patient outcomes, including discharge, ward or intensive care unit (ICU) admission, oxygenation status, and 1-month mortality, were monitored and documented. Results: The study included 202 patients with a mean age of 71 years, comprising 55 females and 147 males. The 1-month mortality rate was found to be 23.8%. A significant correlation was observed between patient outcomes (discharge, ward, or ICU admission) and the Index of Cardiac Electrophysiological Balance (ICEB), with ICU-admitted patients exhibiting significantly lower ICEB values (p=0.005). An ICEB value below 4.0236 was identified as a predictor of ICU admission, with 69% sensitivity and 62.9% specificity (p=0.004). A significant relationship was identified between disease severity and ICEB values, with lower ICEB values associated with more severe cases (p=0.015). An ICEB value below 3.925 predicted severe disease with 90% sensitivity and 62% specificity (p=0.002). Furthermore, a significant association was observed between ICEB values and the need for invasive mechanical ventilation (IMV), with IMV-requiring patients demonstrating markedly lower ICEB values (p=0.005). An ICEB value below 3.88 predicted IMV need with 75% sensitivity and 68.1% specificity (p=0.002). The cutoff value for predicting 1-month mortality was determined as 3.88. Patients with ICEB values>3.88 exhibited significantly higher survival rates compared to those with ICEB values ≤3.88 (p=0.029). Multivariate regression analysis for predicting ICU admission, incorporating independent variables such as ICEB, heart rate, and SpO2, revealed that a one-unit categorical increase in ICEB heightened the probability of ICU admission by 2.312 times (p=0.034). Similarly, regression analysis for predicting IMV requirement, involving ICEB, systolic blood pressure, and heart rate, indicated that a one-unit categorical increase in ICEB increased the likelihood of IMV need by 3.122 times (p=0.038). Conclusion: ICEB serves as a valuable prognostic marker for determining discharge and admission plans, assessing disease severity, and guiding therapeutic strategies in patients presenting with COPD exacerbations in emergency settings. Given its practicality and the ease with which it can be derived from routine ECG assessments, widespread implementation of ICEB in emergency departments holds significant promise. Keywords: COPD, ECG, ICEB, F-QRS-T, SII