Department of Pediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan.
Chang Gung University College of Medicine, Taoyuan, Taiwan.
PLoS One. 2019 Mar 20;14(3):e0214087. doi: 10.1371/journal.pone.0214087. eCollection 2019.
Pediatric myocarditis symptoms can be mild or as extreme as sudden cardiac arrest. Early identification of the severity of illness and timely provision of critical care is helpful; however, the risk factors associated with mortality remain unclear and controversial. We undertook a retrospective review of the medical records of pediatric patients with myocarditis in a tertiary care referral hospital for over 12 years to identify the predictive factors of mortality. Demographics, presentation, laboratory test results, echocardiography findings, and treatment outcomes were obtained. Regression analyses revealed the clinical parameters for predicting mortality. During the 12-year period, 94 patients with myocarditis were included. Of these, 16 (17%) patients died, with 12 succumbing in the first 72 hours after admission. Fatal cases more commonly presented with arrhythmia, hypotension, acidosis, gastrointestinal symptoms, decreased left ventricular ejection fraction, and elevated isoenzyme of creatine kinase and troponin I levels than nonfatal cases. In multivariate analysis, troponin I > 45 ng/mL and left ventricular ejection fraction < 42% were significantly associated with mortality. Pediatric myocarditis had a high mortality rate, much of which was concentrated in the first 72 hours after hospitalization. Children with very high troponin levels or reduced ejection fraction in the first 24 hours were at higher risk of mortality, and targeting these individuals for more intensive therapies may be warranted.
儿科心肌炎的症状可能轻微，也可能严重到心跳骤停。早期识别疾病的严重程度并及时提供重症监护有助于治疗，但与死亡率相关的风险因素仍不清楚且存在争议。我们对一家三级转诊医院 12 多年来的儿科心肌炎患者的病历进行了回顾性分析，以确定死亡率的预测因素。收集了人口统计学、临床表现、实验室检查结果、超声心动图表现和治疗结果等数据。回归分析揭示了预测死亡率的临床参数。在 12 年期间，共纳入了 94 名心肌炎患者。其中，16 名（17%）患者死亡，12 名在入院后 72 小时内死亡。与非致死病例相比，致命病例更常出现心律失常、低血压、酸中毒、胃肠道症状、左心室射血分数降低以及肌酸激酶同工酶和肌钙蛋白 I 水平升高。多变量分析显示，肌钙蛋白 I > 45ng/mL 和左心室射血分数 < 42%与死亡率显著相关。儿科心肌炎的死亡率很高，其中大部分集中在住院后的前 72 小时内。入院后 24 小时内肌钙蛋白水平非常高或射血分数降低的儿童死亡风险更高，可能需要针对这些患者进行更强化的治疗。
