Abstract
Pediatric myocarditis symptoms can be mild or as extreme as sudden cardiac arrest. Early identification of the severity of illness and timely provision of critical care is helpful; however, the risk factors associated with mortality remain unclear and controversial. We undertook a retrospective review of the medical records of pediatric patients with myocarditis in a tertiary care referral hospital for over 12 years to identify the predictive factors of mortality. Demographics, presentation, laboratory test results, echocardiography findings, and treatment outcomes were obtained. Regression analyses revealed the clinical parameters for predicting mortality. During the 12-year period, 94 patients with myocarditis were included. Of these, 16 (17%) patients died, with 12 succumbing in the first 72 hours after admission. Fatal cases more commonly presented with arrhythmia, hypotension, acidosis, gastrointestinal symptoms, decreased left ventricular ejection fraction, and elevated isoenzyme of creatine kinase and troponin I levels than nonfatal cases. In multivariate analysis, troponin I > 45 ng/mL and left ventricular ejection fraction < 42% were significantly associated with mortality. Pediatric myocarditis had a high mortality rate, much of which was concentrated in the first 72 hours after hospitalization. Children with very high troponin levels or reduced ejection fraction in the first 24 hours were at higher risk of mortality, and targeting these individuals for more intensive therapies may be warranted.
Highlights
Myocarditis is a potentially life-threatening inflammatory disorder of the myocardium, which is difficult to diagnose due to its nonspecific and inconsistent clinical presentation [1]
Acute myocarditis was clinically diagnosed on the following basis: (i) symptoms and physical examinations of acute heart failure and rapid deterioration; (ii) history of flu-like illness within the preceding 2 weeks; (iii) cardiomegaly on the chest radiograph, or impaired heart contractility on echocardiography; and (iv) elevation of cardiac enzyme levels [troponin I (TnI) >0.1 ng/mL] or creatine kinase [isoenzyme of creatine kinase (CK-MB) >6.3 ng/mL] [2,12,13,14,15]
The other 20 were diagnosed by a pediatric cardiologist at the time of discharge, including 18 had normal left ventricular ejection fraction (LVEF) (EF≧55%) but with elevated median troponin I level of 5.852 ng/mL, one had normal troponin I level (0.014 ng/mL) but with impaired LVEF (EF:54%), and the other one had normal troponin I level (0.010 ng/mL) but elevated CK-MB level (17 ng/mL)
Summary
Myocarditis is a potentially life-threatening inflammatory disorder of the myocardium, which is difficult to diagnose due to its nonspecific and inconsistent clinical presentation [1]. Signs and symptoms of acute myocarditis in children vary from mild flu-like illness to fatal cardiogenic shock. The mortality rates for infants and children with myocarditis can be as high as 75% and 25%, respectively [3,4,5], and identifying the predictors of death among pediatric myocarditis patients is imperative. Clarifying the risk factors for mortality in children with myocarditis may facilitate effective intensive care and timely provision of circulatory support before circulatory collapse occurs. To address this gap in current knowledge, we aimed to identify the risk factors for mortality in patients with acute myocarditis in order to guide higher-risk patients to higher levels of care
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