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Journals / Hitit Medical Journal / 2026 / Cilt: 8 Sayı: 1

Evaluation of Fragmented QRS in General Surgical ICU Patients: No Association with Short- and Long-Term Mortality

Genel Cerrahi Yoğun Bakım Hastalarında Fragmente QRS’nin Değerlendirilmesi: Kısa ve Uzun Dönem Mortalite ile İlişkisi Yoktur

Ferhan Demirer Aydemir(CANAKKALE ONSEKIZ MART UNIVERSITY, SCHOOL OF MEDICINE)0000-0002-6740-1496
Özgür Kurtkulağı(Mehmet Akif Ersoy State Hospital, Department of General Surgery)0000-0002-9371-0268
Duyg Bilge(DOKUZ EYLÜL ÜNİVERSİTESİ)0000-0002-9846-9848
Volkan Hancı(DOKUZ EYLÜL ÜNİVERSİTESİ)0000-0002-2227-194X
Pages
137–146
Publication Date
2026-02-28
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

These findings highlight the context-dependent value of fQRS and underscore the need for integrative, multivariable risk models rather than reliance on isolated ECG markers.

📌 3 Key Takeaways

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Objective & Hypothesis:Objective: Fragmented QRS (fQRS) on electrocardiography has been proposed as a marker of myocardial conduction heterogeneity and an independent predictor of mortality in various cardiac and medical intensive care populations.
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Key Findings & Data:Methods: This retrospective, single-center observational study included 184 patients admitted to the general surgery ICU between January 2021 and December 2024.
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Conclusion & Impact:These findings highlight the context-dependent value of fQRS and underscore the need for integrative, multivariable risk models rather than reliance on isolated ECG markers.
🔬Design:Modeling & Simulation
📍Scope:2021 Verileri
⚙️Variables:Fragmente QRS · Elektrokardiyografi · Cerrahi Yoğun Bakım Ünitesi

Abstract

Objective: Fragmented QRS (fQRS) on electrocardiography has been proposed as a marker of myocardial conduction heterogeneity and an independent predictor of mortality in various cardiac and medical intensive care populations. However, its prognostic value in general surgical intensive care unit (ICU) patients remains uncertain. Methods: This retrospective, single-center observational study included 184 patients admitted to the general surgery ICU between January 2021 and December 2024. Demographic, clinical, and laboratory data were collected at ICU admission. fQRS was defined as the presence of additional R′ waves, notching, or fragmentation in at least two contiguous leads. The primary outcome was 28-day mortality; in-hospital mortality served as a secondary endpoint. Associations were analyzed using t-tests, chi-square tests, and Pearson correlation coefficients. Results: The mean age of the cohort was 67 ± 15 years, and 55.4% were male. The 28-day and in-hospital mortality rates were 32.1% and 11.4%, respectively. Non-survivors had significantly higher MFI-5 frailty scores (4.5 ± 0.7 vs. 1.4 ± 1.0; p < 0.001), longer ICU stays (6.56 ± 6.06 vs. 4.25 ± 4.20 days; p = 0.003), and higher APACHE II scores (51.5 ± 23.5 vs. 38.1 ± 19.3; p < 0.001). Elevated BUN, creatinine, and lactate, and lower albumin and pH were all associated with mortality (p < 0.001 for each). In contrast, fQRS showed no significant association with either 28-day (p = 0.929) or in-hospital mortality (p = 0.900). Conclusions: In surgical ICU patients, fQRS lacked prognostic significance. Mortality was instead driven by systemic metabolic and physiologic derangements. These findings highlight the context-dependent value of fQRS and underscore the need for integrative, multivariable risk models rather than reliance on isolated ECG markers.

Özet

Arka plan: Elektrokardiyografide (EKG) fragmente QRS (fQRS), miyokardiyal ileti heterojenitesinin bir göstergesi ve çeşitli kardiyak ve medikal yoğun bakım popülasyonlarında mortalitenin bağımsız bir belirleyicisi olarak önerilmiştir. Ancak, genel cerrahi yoğun bakım ünitesi (YBÜ) hastalarında prognostik değeri belirsizliğini korumaktadır. Yöntemler: Bu retrospektif, tek merkezli gözlemsel çalışma, Ocak 2021 ile Aralık 2024 arasında genel cerrahi YBÜ’ye kabul edilen 184 hastayı içermiştir. Demografik, klinik ve laboratuvar verileri YBÜ’ye kabul sırasında toplanmıştır. fQRS, en az iki komşu derivasyonda ek R′ dalgalarının, çentiklenmenin veya fragmantasyonun varlığı olarak tanımlanmıştır. Birincil sonuç 28 günlük mortalite; hastane içi mortalite ise ikincil sonlanım noktası olarak belirlenmiştir. İlişkiler t-testleri, ki-kare testleri ve Pearson korelasyon katsayıları kullanılarak analiz edilmiştir. Bulgular: Kohortun ortalama yaşı 67 ± 15 yıl olup, %55,4’ü erkekti. 28 günlük ve hastane içi mortalite oranları sırasıyla %32,1 ve %11,4 idi. Sağ kalamayan hastalarda MFI-5 kırılganlık skorları anlamlı derecede daha yüksekti (4,5 ± 0,7’e karşı 1,4 ± 1,0; p < 0,001), YBÜ kalış süreleri daha uzundu (6,56 ± 6,06’ya karşı 4,25 ± 4,20 gün; p = 0,003) ve APACHE II skorları daha yüksekti (51,5 ± 23,5’e karşı 38,1 ± 19,3; p < 0,001). Yükselmiş BUN, kreatinin ve laktat, düşük albümin ve pH mortalite ile ilişkiliydi (her biri için p < 0,001). Buna karşılık, fQRS ne 28 günlük mortalite (p = 0,929) ne de hastane içi mortalite (p = 0,900) ile anlamlı ilişki gösterdi. Sonuçlar: Cerrahi YBÜ hastalarında fQRS prognostik önem taşımamıştır. Mortalitenin, bunun yerine sistemik metabolik ve fizyolojik bozulmalar tarafından yönlendirildiği görülmüştür. Bu bulgular, fQRS’nin bağlama bağımlı değerini vurgulamakta ve izole EKG belirteçlerine güvenmek yerine entegre, çok değişkenli risk modellerinin gerekliliğinin altını çizmektedir.

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Cite This Article

Aydemir, F. D., Kurtkulağı, Ö., Bilge, D., Hancı, V. (2026). Evaluation of Fragmented QRS in General Surgical ICU Patients: No Association with Short- and Long-Term Mortality. Hitit Medical Journal, Cilt: 8 Sayı: 1, 137–146. https://doi.org/10.52827/hititmedj.1830257

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