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Background. The COVID-19 pandemic is associated with significant number of complications and mortality and a burden on the healthcare system. In 1015% of hospitalized patients, the invasive and non-invasive mechanical ventilation (IMV/NIMV) is required. At the same time, it is important to stratify the risk of mechanical ventilation upon admission to the hospital. Aims to identify clinical and laboratory risk factors for transfer to IMV and NIMV in hospitalized patients with COVID-19-associated pneumonia. Methods. A retrospective one-center nonrandomized study of 386 consecutive hospitalized patients with COVID-19-associated pneumonia was performed. The primary endpoints were IMV (n=22) and NIMV (n=28). Risk factors of artificial ventilation were considered for periods up to 14 and 28 days for both variants. To select a risk predictor, a univariate analysis based on Cox survival regression was performed, followed by multivariate analysis to determine risk factors at these time points. Results. After 28 days from admission the mortal exit was registered in 20 patients from 386 patients (5.2%). 22 patients (5.7%) were transferred to IMV, and 28 patients (7.3%) to NIV, and 9 of the latter were transferred later to IMV. As a result of univariate and multivariate analyzes, the risk factors for transfer to mechanical ventilation on 14th day were: age 65 years (OR=5.91), a history of stroke (OR=17.04), an increased serum level of urea (OR=6.36), LDH (OR=7.39), decreased sodium (OR=12.32), GFR 80 mL/min/1.73 m2 (OR=13.75) and platelets (OR=4.14); on the 28th day age 65 years (OR=4.58), J-wave on the ECG (OR=2.98), an increase of LDH (OR=9.99) and a decrease in albumin (OR=2.77) in serum. Predictors of the transfer of patients with COVID-19 to NIV within the period up to 14 days from the beginning of hospitalization were the age 65 years (OR=5.09), procalcitonin level in the blood 0.25 ng/ml (OR=0.19), leukocytes 11109 (OR=19.64) and increased LDH (OR=3.9). Conclusions. In patients with COVID-19, the risk factors for transfer to IMV/NIVL in the period of 14 and 28 days from the beginning of hospitalization were identified, which enable patients mechanical ventilation stratification and to plan respiratory support resources.

Introduction: While COVID-19 primarily affects the respiratory system, cardiac injury and unspecific ECG-alterations were reported. J-waves are a common finding observed in 5-6% of routine ECGs. They are also linked to several cardiac pathologies including ventricular tachycardia (VT). However, their incidence and association with acute COVID-19 were not investigated, yet. Methods: To study this issue, we retrospectively investigated admission ECGs in 386 consecutive patients hospitalized in a single center due to acute COVID-19 pneumonia. ECGs were evaluated for the incidence of J-waves and linked to clinical characteristics including 28-days mortality. Results: In contrast to the general population, in acute COVID-19, J-waves were revealed in 12.2% of patients. Patients with J-waves were older, female, with history of stroke or heart failure, and presented with higher BMI and CRP levels. Furthermore, while VT related death (n=1/7) was also observed in the J-wave cohort, mortality was significantly higher in these patients (J-wave: 14.9% vs. no-J-waves 3.8%, p=0.001). Indeed, even after adjusting for further confounders in a multivariable cox regression model, incidence of J-waves, was an independent predictor of mortality at 28-days (OR 2.76 95% CI: 1.15-6.63; p=0.023). While this ECG finding was linked to case fatality, it disappeared or declined during follow-up in 36.4% of COVID-19 survivors initially presented with J-waves. Conclusions: J-waves are a frequent, partially-transient finding in admission ECGs of patients hospitalized with COVID-19. They seem to be an independent predictor of 28-day mortality. Whether such novel feature is specific of COVID-19 and its relation to COVID-19 pathophysiology require further investigation. Funding: None to declare. Conflict of Interest: The authors declare no conflicts of interests. Ethical Approval: The study was performed in accordance with standards of good clinical practice and the principles of the Declaration of Helsinki and approved by the Ethic committee of the Bashkir State Medical University (N11, 2020).

Background J-waves represent a common finding in routine ECGs (5–6%) and are closely linked to ventricular tachycardias. While arrhythmias and non-specific ECG alterations are a frequent finding in COVID-19, an analysis of J-wave incidence in acute COVID-19 is lacking. Methods A total of 386 patients consecutively, hospitalized due to acute COVID-19 pneumonia were included in this retrospective analysis. Admission ECGs were analyzed, screened for J-waves and correlated to clinical characteristics and 28-day mortality. Results J-waves were present in 12.2% of patients. Factors associated with the presence of J-waves were old age, female sex, a history of stroke and/or heart failure, high CRP levels as well as a high BMI. Mortality rates were significantly higher in patients with J-waves in the admission ECG compared to the non-J-wave cohort (J-wave: 14.9% vs. non-J-wave 3.8%, p = 0.001). After adjusting for confounders using a multivariable cox regression model, the incidence of J-waves was an independent predictor of mortality at 28-days (OR 2.76 95% CI: 1.15–6.63; p = 0.023). J-waves disappeared or declined in 36.4% of COVID-19 survivors with available ECGs for 6–8 months follow-up. Conclusion J-waves are frequently and often transiently found in the admission ECG of patients hospitalized with acute COVID-19. Furthermore, they seem to be an independent predictor of 28-day mortality.