Division of Cardiology, Department of Internal Medicine, and Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
BMC Cardiovasc Disord. 2021 Nov 30;21(1):571. doi: 10.1186/s12872-021-02386-8.
We sought to describe the tendency and extent of high-sensitivity cardiac troponin I (hs-cTnI) changes in patients with fulminant myocarditis (FM) after admission and to explore the relationship between the in-hospital mortality of FM and the absolute and relative changes in hs-cTnI within 24 h and 48 h after admission.
In the retrospective study, the object are patients diagnosed with FM in our single centre. The value of cardiac troponin was recorded after patients admitted to hospital in succession. The absolute and relative changes in hs-cTnI within 24 h and 48 h were described as range distributions. Receiver operating characteristic (ROC) curve and Cox analyses were performed to determine the relationship between in-hospital mortality of FM and hs-cTnI changes.
A total of 83 FM patients admitted to our centre from January 1, 2010 to December 31, 2019 were included; 69 patients survived and 14 patients died. In the survival group, 78% of patients experienced a decline in hs-cTnI within 24 h, while 36% of the mortality group exhibited a declining tendency in hs-cTnI (P = 0.003). Nearly 60% of survival group had a 0-2000 ng/l reduction in troponin from baseline within 24 h of admission. However, troponin levels of 50% of patients in the mortality group were 0-10,000 ng/ L higher than baseline 24 h after admission. Multivariable logistic analysis revealed that the declining tendency of hs-cTnI within 24 h, in addition to time from onset to admittance to hospital, intravenous immunoglobulin treatment and the abnormal level of creatinine, were associated with the in-hospital mortality of FM (for the declining tendency of hs-cTnI within 24 h, OR = 0.10, 95% CI 0.02-0.68, P = 0.018). The ROC curve revealed optimal cut-off values of - 618 ng/l for absolute change within 24 h (AUC = 0.800, P < 0.01), - 4389 ng/l for absolute change within 48 h (area under the curve = 0.711, P < 0.01), - 28.46% for relative change within 24 h (AUC = 0.810, P < 0.01), and - 52.23% for relative change within 48 h (AUC = 0.795, P < 0.01). Absolute changes and relative changes in hs-cTnI within 24 h and 48 h were strong predictors of in-hospital mortality by Cox regression analysis after adjustment for sex, time from onset to admission, and occurrence of ventricular tachycardia or ventricular fibrillation.
Most FM patients who survived experienced a decline in hs-cTnI within 24 h. The absolute and relative changes in hs-cTnI within 24 h and 48 h were strong predictors of in-hospital mortality.
本研究旨在描述暴发性心肌炎（FM）患者入院后高敏心肌肌钙蛋白 I（hs-cTnI）的变化趋势和幅度，并探讨入院后 24 h 和 48 h 内 hs-cTnI 的绝对和相对变化与 FM 院内死亡率之间的关系。
本回顾性研究纳入了在我院确诊为 FM 的患者。连续记录患者入院后的心肌肌钙蛋白值。描述入院后 24 h 和 48 h 内 hs-cTnI 的绝对和相对变化范围分布。通过受试者工作特征（ROC）曲线和 Cox 分析确定 FM 院内死亡率与 hs-cTnI 变化之间的关系。
共纳入 2010 年 1 月 1 日至 2019 年 12 月 31 日期间我院收治的 83 例 FM 患者，其中 69 例存活，14 例死亡。在存活组中，78%的患者在入院后 24 h 内 hs-cTnI 下降，而死亡率组中 36%的患者 hs-cTnI 呈下降趋势（P = 0.003）。近 60%的存活组患者在入院后 24 h 内的肌钙蛋白值较基线降低了 0-2000 ng/l。然而，死亡率组中 50%的患者在入院后 24 h 的肌钙蛋白值较基线升高了 0-10000 ng/l。多变量逻辑分析显示，入院后 24 h 内 hs-cTnI 的下降趋势，除了发病到入院的时间、静脉注射免疫球蛋白治疗和肌酐水平异常外，与 FM 的院内死亡率相关（对于入院后 24 h 内 hs-cTnI 的下降趋势，OR = 0.10，95%CI 0.02-0.68，P = 0.018）。ROC 曲线显示，入院后 24 h 内绝对变化的最佳截断值为-618 ng/l（AUC = 0.800，P < 0.01），入院后 48 h 内绝对变化的最佳截断值为-4389 ng/l（曲线下面积 = 0.711，P < 0.01），入院后 24 h 内相对变化的最佳截断值为-28.46%（AUC = 0.810，P < 0.01），入院后 48 h 内相对变化的最佳截断值为-52.23%（AUC = 0.795，P < 0.01）。校正性别、发病至入院时间和室性心动过速或心室颤动发生后， Cox 回归分析显示，入院后 24 h 和 48 h 的 hs-cTnI 绝对和相对变化是院内死亡率的强烈预测因子。
大多数存活的 FM 患者在入院后 24 h 内 hs-cTnI 下降。入院后 24 h 和 48 h 的 hs-cTnI 的绝对和相对变化是 FM 院内死亡率的强预测因子。
