Electrical Risk Score derived from standard ECG predicts mortality in sepsis patients presenting to the emergency department.

BACKGROUND

Sepsis remains a leading cause of morbidity and mortality among patients presenting to the emergency department (ED), and early risk stratification is crucial for clinical decision-making. However, commonly used severity scores rely on laboratory parameters and may not be readily applicable at initial ED presentation.

OBJECTIVES

This study aimed to investigate the association between an electrocardiography-derived Electrical Risk Score (ERS) calculated at ED admission and in-hospital mortality in sepsis patients requiring intensive care unit (ICU) admission, and to compare its prognostic performance with the Sequential Organ Failure Assessment (SOFA) score.

METHODS

In this retrospective cohort study, adult patients diagnosed with sepsis in the ED and subsequently admitted to the ICU between January 2023 and December 2024 were analyzed. ERS was calculated from standard 12-lead ECGs obtained at ED presentation based on six predefined electrocardiographic parameters. SOFA and APACHE II scores were recorded at ICU admission. Demographic characteristics, comorbidities, laboratory findings, mechanical ventilation requirement, and clinical outcomes were retrieved from electronic medical records. Multivariable logistic regression analysis was performed to identify independent predictors of in-hospital mortality.

RESULTS

Of 256 patients, 164 (64.1 %) died in hospital. Non-survivors were older and had higher SOFA (median 10 vs. 6.5, p < 0.001) and APACHE II scores (32 vs. 23.5, p < 0.001). ERS was significantly higher in non-survivors (p = 0.001), with QTc prolongation more prevalent in this group (p = 0.037). In multivariable analysis, both ERS (OR 1.818; 95 % CI 1.085-3.045; p = 0.023) and SOFA (OR 1.177; 95 % CI 1.033-1.340; p = 0.014) independently predicted in-hospital mortality.

CONCLUSION

ERS calculated from admission ECGs was independently associated with in-hospital mortality in sepsis patients admitted from the ED to the ICU. These findings suggest that ERS may serve as a complementary, hypothesis-generating risk marker for early risk stratification, pending further prospective validation.