Abstract
Acute myocarditis is an uncommon and potentially life-threatening disease. Scoring systems are essential for predicting outcome and evaluating the therapy effect of adult patients with acute myocarditis. The aim of this study was to determine the value of the Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation IV (APACHE IV) and second Simplified Acute Physiology Score (SAPS II) scoring systems in predicting short-term mortality of these patients. We retrospectively analyzed data from 305 adult patients suffering from acute myocarditis between April 2005 and August 2016. The association between the value of admission SOFA, APACHE IV and SAPS II scores and risk of short-term mortality was determined. Multivariate Cox analysis showed that SOFA, APACHE IV and SAPS II scores were independent risk factors of death in patients with acute myocarditis. For each scoring system, Kaplan–Meier analysis showed that the cumulative short-term mortality was significantly higher in patients with higher admission scores compared with those with lower admission scores. For the prediction of short-term mortality in a patient with acute myocarditis, SAPS II had the highest accuracy followed by the APACHE IV and SOFA scores.
Highlights
Myocarditis is an inflammatory disease of myocardium with a wide range of clinical presentations, from complete healing to severe congestive heart failure, leading to death or requiring a heart transplant [1]
The aim of this study was to determine the value of the Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation IV (APACHE IV) and second Simplified Acute Physiology Score (SAPS II) scoring systems in predicting short-term mortality of these patients
For the prediction of short-term mortality in a patient with acute myocarditis, SAPS II had the highest accuracy followed by the APACHE IV and SOFA scores
Summary
Myocarditis is an inflammatory disease of myocardium with a wide range of clinical presentations, from complete healing to severe congestive heart failure, leading to death or requiring a heart transplant [1]. Some clinical markers or risk factors, including syncope [2], New York Heart Association (NYHA) Functional class [3], right ventricular dysfunction [4], acute kidney injury (AKI) [5] as well as elevated troponin I [6] and pulmonary artery pressure [7], presence of antiheart autoantibodies [8] and prolonged QRS duration≥120 ms [9] have been shown to predict the elevated risks of cardiac death or heart transplantation in patients with acute myocarditis. Immunohistologic signs of inflammation (CD3 and/or CD68) were predictors of increased risk of death [3]. These markers were not commonly used for clinical test. A risk stratification approach based on clinical findings providing information on the various myocarditis induced injuries could help us to identify patients with a potentially unfavorable prognosis
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