QRS voltage is a predictor of in‐hospital mortality of acutely ill medical patients

Background Low QRS voltage has been shown to be associated with increased mortality in the general population and in a small pilot study the combined QRS voltage of ECG leads I and II was found to be associated with in‐hospital mortality. Hypothesis Confirm that low QRS voltage predicts the in‐hospital mortality of acutely ill patients, and compare QRS voltage with other predictors of mortality that can be easily, quickly and cheaply obtained at the bedside. Methods Prospective observational study of vital signs, QRS voltage and simple tools used to assess mental, functional and nutritional status at the bedside in unselected acutely ill patients admitted to a resource‐poor hospital in sub‐Saharan Africa. Results Out of 1486 patients, 77 died (5.2%) in hospital. A combined lead I + II voltage <1.8 mV was present in 789 (53.1%) of patients, and significantly associated with in‐hospital mortality (odds ratio 3.6, 95% CI 2.0‐6.5, χ 2 21.2, P < 0.00001). On logistic regression impaired mobility, the National Early Warning Score, male gender and lead I + II voltage were the only independent predictors of mortality. None of the 445 patients who were mobile on admission with a lead I + II voltage ≥ 1.8 mV died in hospital. Conclusions Low QRS voltage, male gender, NEWS, and impaired mobility were independent predictors of in‐hospital mortality in the study population. These four variables, which are easily obtained at the bedside, could potentially provide a rapid, easy, and cheap risk stratification system.