Butto Arene, Rossano Joseph W, Nandi Deipanjan, Ravishankar Chitra, Lin Kimberly Y, O'Connor Matthew J, Shaddy Robert E, Shamszad Pirouz
Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Division of Cardiology, The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA.
Pediatr Cardiol. 2018 Aug;39(6):1139-1143. doi: 10.1007/s00246-018-1871-2. Epub 2018 Apr 13.
Serum troponin (Tn) is often elevated in viral myocarditis; however, its prognostic significance is unknown. We tested the hypothesis that abnormal serum Tn is associated with mortality in children hospitalized with myocarditis. We retrospectively studied data from six large children's hospitals participating in the Pediatric Health Information System Plus (PHIS+) database. Analysis was performed on patients hospitalized with viral myocarditis between 2007 and 2013, in whom at least one Tn was recorded within 72 h of admission. Abnormal baseline Tn was defined as any value outside the upper limit of normal within the first 72 h. Primary outcome was mortality. Secondary outcomes included mechanical support, defined as use of extracorporeal membrane oxygenation (ECMO) or a ventricular assist device (VAD), cardiac transplantation, intravenous immunoglobulin (IVIg), mechanical ventilation, and inotrope use. A total of 149 patients with myocarditis (61% male, 48% adolescents) across all PHIS+ centers had TnI (n = 113) or TnT (n = 36) recorded. At least one abnormal Tn was present in 81% of cases. Overall mortality was 7.3% and was not associated with abnormal baseline Tn. Abnormal baseline Tn was associated with ECMO (7.1 vs. 25.6%, p = 0.03) and IVIg (46.4 vs. 83.5%, p < 0.001). Abnormal baseline Tn was not associated with transplantation, mechanical ventilation or inotrope use. Abnormal Tn in the first 72 h of hospitalization for myocarditis was associated with the use of ECMO and IVIg, but was not associated with mortality. This finding may help risk stratify this population if it can be prospectively validated.
血清肌钙蛋白（Tn）在病毒性心肌炎中常升高；然而，其预后意义尚不清楚。我们检验了这样一个假设，即血清Tn异常与心肌炎住院儿童的死亡率相关。我们回顾性研究了参与儿科健康信息系统升级版（PHIS+）数据库的六家大型儿童医院的数据。对2007年至2013年间因病毒性心肌炎住院且入院72小时内至少记录过一次Tn的患者进行分析。异常基线Tn定义为入院后72小时内超出正常上限的任何值。主要结局是死亡率。次要结局包括机械支持，定义为使用体外膜肺氧合（ECMO）或心室辅助装置（VAD）、心脏移植、静脉注射免疫球蛋白（IVIg）、机械通气和使用血管活性药物。所有PHIS+中心共有149例心肌炎患者（61%为男性，48%为青少年）记录了肌钙蛋白I（TnI，n = 113）或肌钙蛋白T（TnT，n = 36）。81%的病例至少有一次Tn异常。总体死亡率为7.3%，与异常基线Tn无关。异常基线Tn与ECMO（7.1%对25.6%，p = 0.03）和IVIg（46.4%对83.5%，p < 0.001）相关。异常基线Tn与移植、机械通气或使用血管活性药物无关。心肌炎住院后72小时内Tn异常与ECMO和IVIg的使用相关，但与死亡率无关。如果这一发现能够得到前瞻性验证，可能有助于对该人群进行风险分层。
