Abrar Shahla, Ansari Mohammed Junaid, Mittal Mahima, Kushwaha K P
Senior Resident, Department of Paediatrics, B.R.D. Medical College , Gorakhpur, India .
Lecturer, Department of Paediatrics, B.R.D. Medical College , Gorakhpur, India .
J Clin Diagn Res. 2016 Jun;10(6):SC12-6. doi: 10.7860/JCDR/2016/19856.7967. Epub 2016 Jun 1.
Paediatric myocarditis can present as mild flu like symptoms to fulminent form. Early identification of the severity of illness and prioritization of intensive care is helpful especially in developing countries with limited resources.
To know the factors at admission that can predict mortality in paediatric myocarditis.
This was an observational study which enrolled children who presented with fever of acute onset (less than 15 days in duration), and were diagnosed as suspected myocarditis on the basis of clinical features, Troponin I and echocardiography, according to Expanded criteria for myocarditis in Paediatric ward at our institute over a period from August 2014 to December 2015. Their clinical features, cardiac biomarkers and echocardiography findings were compared between survivors and non-survivors.
All statistical analysis was done using graphpad Prism 5 and SPSS statistical software. A Fisher exact p-value <0.05 was regarded as significant. Multivariate Logistic Regression was carried out to quantify the relationship between cardiac death and other predictor variables. The logistic coefficients for the predictor variables and their exponents, that is, log odds were calculated. Statistical significance of these predictor variables was interpreted by p-values.
A 17.7% (n=11/62) patients of paediatric myocarditis died in this study. New York Heart Association (NYHA) class IV dyspnea (p=0.0115) and hypotension (p=0.0174) were more in patients who did not survive. The mean value of Troponin I was more in the non-survivor group (0.958 ± 1.13ng/ml); (p=0.0074). More number of patients who died had Brain Natriuretic Peptide (BNP) levels increased in their plasma (p=0.0087) with higher mean value (p=0.0175). LV ejection fraction was decreased markedly in non survivor group with mean value of 37±8.09 % as compared to survivor group with mean value of 46.6±10.5%, (p=0.0115). On multivariate analysis, NYHA class IV dyspnea (p=0.0113), BNP (p=0.015) and ejection fraction (p = 0.0284) independently are the predictors of mortality in our study group.
Children with myocarditis having hypotension, raised Troponin I, BNP and decreased ejection fraction are more prone to die. NYHA IV dyspnea, higher levels of BNP and decreased EF are independently related to worst outcome.
小儿心肌炎的症状可从轻微的流感样症状到暴发性形式。尽早识别疾病的严重程度并优先进行重症监护很有帮助，尤其是在资源有限的发展中国家。
了解入院时可预测小儿心肌炎死亡率的因素。
这是一项观察性研究，纳入了急性起病发热（病程少于15天）、根据我院儿科病房心肌炎扩展标准基于临床特征、肌钙蛋白I和超声心动图被诊断为疑似心肌炎的儿童。在2014年8月至2015年12月期间对幸存者和非幸存者的临床特征、心脏生物标志物和超声心动图结果进行了比较。
所有统计分析均使用GraphPad Prism 5和SPSS统计软件进行。Fisher精确p值<0.05被视为具有统计学意义。进行多因素逻辑回归以量化心源性死亡与其他预测变量之间的关系。计算预测变量的逻辑系数及其指数，即对数优势。这些预测变量的统计学意义通过p值来解释。
本研究中17.7%（n = 11/62）的小儿心肌炎患者死亡。未存活患者中纽约心脏协会（NYHA）IV级呼吸困难（p = 0.0115）和低血压（p = 0.0174）更为常见。非存活组肌钙蛋白I的平均值更高（0.958±1.13ng/ml）；（p = 0.0074）。死亡患者中血浆脑钠肽（BNP）水平升高的人数更多（p = 0.0087），平均值更高（p = 0.0175）。非存活组左心室射血分数明显降低，平均值为37±8.09%，而存活组平均值为46.6±10.5%，（p = 0.0115）。多因素分析显示，NYHA IV级呼吸困难（p = 0.0113）、BNP（p = 0.015）和射血分数（p = 0.0284）独立地是我们研究组死亡率的预测因素。
患有低血压、肌钙蛋白I升高、BNP升高和射血分数降低的心肌炎患儿更容易死亡。NYHA IV级呼吸困难、较高的BNP水平和降低的EF与最差结局独立相关。
