All authors: Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Genomics Research Center, Academia Sinica, Taiwan Administration of National Health Insurance, Taipei, Taiwan.
Pediatr Crit Care Med. 2017 Dec;18(12):1153-1158. doi: 10.1097/PCC.0000000000001363.
Acute myocarditis can be lethal, but the incidence remains unclear because of its wide manifestation spectrum. We investigated the postnatal incidence of acute myocarditis and risk factors for morbidity and mortality.
Retrospective derived birth cohort study.
Taiwan National Health Insurance Database for the period 2000-2014.
Children born between 2000 and 2009 with complete postnatal medical care data for at least 5 years.
None.
From among 2,150,590 live births, we identified 965 patients (54.8% male) admitted with the diagnosis of acute myocarditis, accounting for an overall incidence of 0.45/1,000. The cumulative incidence rates were 0.19/1,000, 0.38/1,000, 0.42/1,000, and 0.48/1,000 by ages 1, 5, 10, and 15 years, respectively. Male predominance was noted in infants and school age children (age group 6-14 yr). Arrhythmias, including tachyarrhythmia (4.8%) and bradyarrhythmia (1.1%), occurred in 56 patients. Extracorporeal membrane oxygenation support was provided to 62 patients (6.4%) and additional left ventricular assist devices in six of them. The mortality at discharge was 6.3%. The presence of ventricular tachyarrhythmia, bradyarrhythmia, and an onset at school age (6-14 yr) were associated with increased odds for the need for extracorporeal membrane oxygenation, which was the only predictor for mortality at discharge (hazard ratio, 7.85; 95% CI, 3.74-9.29). In patients who survived the acute myocarditis, late mortality was relatively low (36/904 = 4.0%). The overall survival of children with acute myocarditis were 90.9%, 90.3%, and 89.8% by the intervals of 1, 5, and 10 years after the myocarditis, respectively.
This birth cohort study determined the cumulative incidence of acute myocarditis for neonates by 15 years old to be one in 2,105. In an era of extracorporeal membrane oxygenation, the need of extracorporeal membrane oxygenation may reflect the severity of acute myocarditis and predict its outcome.
急性心肌炎可能致命，但由于其临床表现广泛，其发病率仍不清楚。我们研究了急性心肌炎的产后发病率以及发病和死亡的危险因素。
回顾性衍生出生队列研究。
2000-2014 年台湾全民健康保险数据库。
2000 年至 2009 年出生的儿童，至少有 5 年完整的产后医疗数据。
无。
在 2150590 例活产儿中，我们共识别出 965 例（54.8%为男性）因急性心肌炎入院的患者，其总发病率为 0.45/1000。年龄为 1、5、10 和 15 岁时，累积发病率分别为 0.19/1000、0.38/1000、0.42/1000 和 0.48/1000。在婴儿和学龄儿童（6-14 岁年龄组）中观察到男性优势。心律失常，包括心动过速（4.8%）和心动过缓（1.1%），发生在 56 例患者中。62 例患者（6.4%）接受体外膜氧合支持，其中 6 例患者接受额外的左心室辅助设备。出院时死亡率为 6.3%。室性心动过速、心动过缓以及发病年龄在学龄期（6-14 岁）与需要体外膜氧合的几率增加相关，而体外膜氧合是出院时唯一的死亡预测因子（危险比，7.85；95%置信区间，3.74-9.29）。在存活的急性心肌炎患者中，晚期死亡率相对较低（36/904=4.0%）。急性心肌炎后 1、5 和 10 年，儿童总体生存率分别为 90.9%、90.3%和 89.8%。
本出生队列研究确定了新生儿至 15 岁时急性心肌炎的累积发病率为 1/2105。在外膜氧合时代，体外膜氧合的需求可能反映了急性心肌炎的严重程度并预测其结局。
