Cardiology Department, Reina Sofía University Hospital, Córdoba, Spain.
Cardiology Department, Hospital Quirón Salud, Córdoba, Spain.
Eur J Clin Invest. 2021 Apr;51(4):e13444. doi: 10.1111/eci.13444. Epub 2020 Nov 26.
There are no data on population-based epidemiological changes in acute myocarditis in Europe. Our aim was to evaluate temporal trends in incidence, clinical features and outcomes of hospital treated acute myocarditis (AM) in Spain from 2003 to 2015.
We conducted a retrospective longitudinal study using information of all hospital discharges of the Spanish National Health System. All episodes with a discharge diagnosis of AM from 1 January 2003 to 31 December 2015 were included. The risk-standardized in-hospital mortality ratio (RSMR) was calculated using a multilevel risk-adjustment model developed by the Medicare and Medicaid Services. Temporal trends for in-hospital mortality were modelled using Poisson regression analysis.
A total of 11 147 episodes of AM were analysed, most of them idiopathic (94.7%). The rate of AM discharges increased along the period, from 13 to 30/million inhabitants/year (2003-2015), and this increase was statistically significant when weighted by age and sex (incidence rate ratio, IRR 1.06, 95% CI 1.04-1.08, P = .001). In-hospital crude mortality rate was 3.1%, diminishing significantly along 2003-2015 (IRR 0.95, 95% CI 0.92-0.99, P = .02). RSMR also significantly diminished along the period (IRR 0.95, 95% CI 0.92-0.99, P = .01). Renal failure (OR 7.03, 5.38-9.18, P = .001), liver disease (OR 4.61, 2.59-8.21, P = .001), pneumonia (OR 4.13, 2.75-6.20, P = .001) and heart failure (OR 1.91, 95% CI 1.47-2.47, P = .001) were the strongest independent factors associated with in-hospital mortality.
Acute myocarditis is an uncommon entity, although hospital discharges have increased in Spain along the study period. Most of AM were idiopathic. Adjusted mortality was low and seemed to decrease from 2003 to 2015, suggesting an improvement in AM management.
欧洲尚无关于急性心肌炎的基于人群的流行病学变化的数据。我们的目的是评估 2003 年至 2015 年期间西班牙住院治疗的急性心肌炎（AM）的发病率、临床特征和结局的时间趋势。
我们使用西班牙国家卫生系统的所有住院患者信息进行了回顾性纵向研究。纳入了 2003 年 1 月 1 日至 2015 年 12 月 31 日期间出院诊断为 AM 的所有病例。使用由医疗保险和医疗补助服务局开发的多层次风险调整模型计算风险标准化住院死亡率比（RSMR）。使用泊松回归分析对住院死亡率的时间趋势进行建模。
共分析了 11147 例 AM 病例，其中大多数为特发性（94.7%）。AM 出院率随时间推移而增加，从 13/100 万居民/年增加到 30/100 万居民/年（2003-2015 年），且经年龄和性别加权后增加具有统计学意义（发病率比，IRR 1.06，95%CI 1.04-1.08，P=0.001）。住院死亡率为 3.1%，2003-2015 年间显著降低（IRR 0.95，95%CI 0.92-0.99，P=0.02）。同期 RSMR 也显著降低（IRR 0.95，95%CI 0.92-0.99，P=0.01）。肾功能衰竭（OR 7.03，95%CI 5.38-9.18，P=0.001）、肝病（OR 4.61，95%CI 2.59-8.21，P=0.001）、肺炎（OR 4.13，95%CI 2.75-6.20，P=0.001）和心力衰竭（OR 1.91，95%CI 1.47-2.47，P=0.001）是与住院死亡率相关的最强独立因素。
急性心肌炎虽然少见，但在研究期间西班牙的住院人数有所增加。大多数 AM 为特发性。校正死亡率较低，且似乎从 2003 年到 2015 年有所下降，表明 AM 管理有所改善。
