Abstract
We aimed to evaluate the outcomes of patients with fulminant myocarditis and investigate the factors associated with mortality. This is a retrospective single-center cohort study that included adult and pediatric patients with fulminant myocarditis treated at Samsung Medical Center between September 2004 and December 2019. The primary outcome was in-hospital mortality. Among 100 patients, 71 underwent veno-arterial extracorporeal membrane oxygenation (ECMO) (ECMO group). Comorbidities were not significantly different between the ECMO and non-ECMO groups. Cardiac enzymes, creatinine, and median sequential organ failure assessment (SOFA) score at intensive care unit admission were significantly different between the groups. Twenty patients (28.7%) in the ECMO group and two (6.9%) in the non-ECMO group died in-hospital (p = 0.02). The significant risk factors of in-hospital mortality were creatine kinase MB fraction (CK-MB) and SOFA score (p = 0.009 and p = 0.001, respectively) in the ECMO group. In the receiver-operating characteristic curve analysis, the cutoffs of SOFA score and CK-MB were 12 and 94.74 ng/mL, respectively. The patients with both variables above the cutoffs showed significantly worse outcomes (p < 0.001). ECMO can be an effective treatment option for fulminant myocarditis. SOFA score and CK-MB are significant risk factors for in-hospital mortality.
Highlights
Acute myocarditis is a disease with a broad spectrum of clinical presentations that range from flu-like illness to cardiogenic shock or even death
This study evaluated the outcomes of patients with fulminant myocarditis and the risk factors associated with in-hospital mortality
We found that the sequential organ failure assessment (SOFA) score was a significant risk factor associated with in-hospital mortality from fulminant myocarditis
Summary
Acute myocarditis is a disease with a broad spectrum of clinical presentations that range from flu-like illness to cardiogenic shock or even death. Acute myocarditis with hemodynamic instability, so-called fulminant myocarditis, has not yet been well characterized, despite its risk of fatal outcomes. As the utilization of extracorporeal membrane oxygenation (ECMO) has increased, its use in cases of fulminant myocarditis has increased [1,2]. Few studies have investigated the use of ECMO support for patients with fulminant myocarditis. The risk factors that are associated with outcomes of fulminant myocarditis are not well established. Some studies have reported that poor left ventricular systolic function and arrhythmias were associated with poor clinical outcomes [3,4]. There were several publications that reported that these variables did not contribute to the prognosis of acute myocarditis [5]
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