Zhang Qian, Zhao Rui
Department of Heart Center, Peking University People's Hospital, Beijing 100044, China.
World J Clin Cases. 2020 Nov 26;8(22):5547-5554. doi: 10.12998/wjcc.v8.i22.5547.
Adult severe myocarditis is primarily caused by infection with any number of a variety of viruses. It arises quickly, progresses rapidly, and may lead to severe heart failure or circulatory failure presenting as rapid-onset hypotension and cardiogenic shock with a high hospital mortality rate.
To analyze the risk factors affecting the short-term prognosis of adult acute severe myocarditis (ASM).
Adult patients with ASM (ASM group, = 218) and acute nonsevere myocarditis (ANSM group, = 80) who came to our department from January 2014 to January 2020 were enrolled in this study. Patients with ASM were divided into the ASM survival group ( = 185) and ASM nonsurvival group ( = 33) according to the treatment results during hospitalization. The clinical symptoms, laboratory examinations, treatment methods, complications, and the relationship between the treatment results of the two groups were retrospectively compared and discussed. The risk factors for death in patients with severe myocarditis were analyzed by binary logistic regression. A follow-up to 5.5 years was conducted on patients in the ASM survival group and ANSM group after discharge, and the readmission rate and incidence rate of dilated cardiomyopathy were analyzed.
Compared with the ASM survival group, the ASM nonsurvival group had longer QRS complex, higher incidence of cardiogenic shock, higher serum creatinine (SCr, 235μmol/L 89 μmol/L, < 0.05), higher sensitive cardiac troponin I (cTnI, 4.45 μg/L 1.66 μg/L, < 0.05) and brain natriuretic peptide (BNP, 1756 pg/mL 401 pg/mL, < 0.05). The binary logistic regression revealed that there were statistical differences between the two groups in SCr, cTnI, and BNP values (all < 0.05). After discharging from the hospital, patients in the ASM group and ANSM group had no significant differences in the readmission rate and incidence rate of dilated cardiomyopathy.
Elevated SCr, cTnI, and BNP are independent predictors for poor prognosis in patients with ASM. The long-term prognosis of patients in the ASM survival group is good.
成人重症心肌炎主要由多种病毒中的任何一种感染引起。其起病迅速，进展迅猛，可能导致严重心力衰竭或循环衰竭，表现为快速出现的低血压和心源性休克，医院死亡率较高。
分析影响成人急性重症心肌炎（ASM）短期预后的危险因素。
选取2014年1月至2020年1月来我院就诊的成人ASM患者（ASM组，n = 218）和急性非重症心肌炎患者（ANSM组，n = 80）纳入本研究。ASM患者根据住院期间的治疗结果分为ASM存活组（n = 185）和ASM非存活组（n = 33）。回顾性比较并讨论两组患者的临床症状、实验室检查、治疗方法、并发症以及治疗结果之间的关系。采用二元logistic回归分析重症心肌炎患者死亡的危险因素。对ASM存活组和ANSM组患者出院后进行5.5年的随访，分析再入院率和扩张型心肌病发病率。
与ASM存活组相比，ASM非存活组QRS波群时限更长，心源性休克发生率更高，血清肌酐（SCr，235μmol/L对89μmol/L，P < 0.05）、超敏心肌肌钙蛋白I（cTnI，4.45μg/L对1.66μg/L，P < 0.05）和脑钠肽（BNP，1756 pg/mL对401 pg/mL，P < 0.05）水平更高。二元logistic回归显示，两组患者的SCr、cTnI和BNP值存在统计学差异（均P < 0.05）。出院后，ASM组和ANSM组患者再入院率和扩张型心肌病发病率无显著差异。
SCr、cTnI和BNP升高是ASM患者预后不良的独立预测因素。ASM存活组患者的长期预后良好。
