Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Department of Pediatric Emergency Care, Izmir, Turkey.
Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Department of Pediatric Emergency Care, Izmir, Turkey.
Arch Pediatr. 2022 Jul;29(5):376-380. doi: 10.1016/j.arcped.2022.03.008. Epub 2022 May 27.
To evaluate the factors associated with intensive care requirement and mortality in pediatric myocarditis.
Children aged 28 days to 18 years who were diagnosed with acute myocarditis in a pediatric emergency department between January 2010 and September 2020 were enrolled in the study retrospectively. Demographic and clinical features, cardiac biomarkers, and imaging findings were evaluated. Length of hospital stay, need for hospitalization in the pediatric intensive care unit (PICU), treatments, and survival outcomes were recorded. To define the severity of disease, three groups were created and the data were compared in terms of clinical, laboratory, and imaging findings. The patients treated in the pediatric ward were compared with those hospitalized in the PICU. Ventricular dysfunction was defined in patients with a left ventricular ejection fraction (LVEF) of <50% and these patients were compared with those who had an LVEF of >50%. Also, survivor and non-survivor patients were compared.
A total number of 62 patients with a median age of 8 years were included. Chest pain and tachycardia were the most common findings on physical examination. The mean LVEF was 59.3 ± 13.0% at admission. Of the patients, 17 were hospitalized in the PICU (27.4%). Chest pain was more common in patients hospitalized in the pediatric ward (p<0.001), and hypotension, vomiting, arrhythmia, were more common and LVEF was lower in patients in the PICU (p = 0.017, p = 0.008, p = 0.006, and p = 0.025, respectively). The children treated in the PICU were younger than those in the pediatric ward (p = 0.009). Troponin I levels were significantly higher in the pediatric ward (p = 0.035), and brain natriuretic peptide (BNP) levels were higher in patients in the PICU (p = 0.012). Death occurred in four patients. Hypotension and vomiting were significantly more common in non-survivors (p = 0.020 and 0.004, respectively). Inotropes and intravenous immunoglobulin (IVIG) were more commonly used in non-survivors (p = 0.001 and p = 0.015, respectively). BNP levels were higher in non-survivors (p = 0.008), and troponin I levels were not different between survivors and non-survivors (p = 0.260).
In pediatric acute myocarditis, lower LVEF, increased BNP, as well as the presence of hypotension and arrhythmia were found to be related to intensive care requirement. Hypotension and vomiting were found to be more common in non-survivors. Due to the possibility of rapidly worsening disease, physicians should be alert to the presence of these findings.
评估与儿科心肌炎患者需要重症监护和死亡相关的因素。
回顾性纳入 2010 年 1 月至 2020 年 9 月期间在儿科急诊科被诊断为急性心肌炎的 28 天至 18 岁儿童患者。评估了人口统计学和临床特征、心脏生物标志物和影像学发现。记录了住院时间、需要入住儿科重症监护病房（PICU）、治疗和生存结果。为了定义疾病的严重程度，创建了三个组，并比较了临床、实验室和影像学发现。将在儿科病房接受治疗的患者与在 PICU 住院的患者进行了比较。左心室射血分数（LVEF）<50%的患者被定义为心室功能障碍，将这些患者与 LVEF>50%的患者进行了比较。此外，还比较了幸存者和非幸存者患者。
共纳入 62 例中位年龄为 8 岁的患者。体格检查时最常见的发现是胸痛和心动过速。入院时平均 LVEF 为 59.3±13.0%。其中 17 例患者入住 PICU（27.4%）。胸痛在儿科病房住院的患者中更为常见（p<0.001），低血压、呕吐、心律失常更为常见，且 PICU 患者的 LVEF 较低（p=0.017、p=0.008、p=0.006 和 p=0.025）。PICU 治疗的患儿比儿科病房的患儿年龄更小（p=0.009）。肌钙蛋白 I 水平在儿科病房显著升高（p=0.035），而脑钠肽（BNP）水平在 PICU 患者中更高（p=0.012）。四名患者死亡。非幸存者中低血压和呕吐更为常见（p=0.020 和 0.004）。非幸存者中更常使用正性肌力药物和静脉注射免疫球蛋白（IVIG）（p=0.001 和 p=0.015）。非幸存者中 BNP 水平较高（p=0.008），幸存者和非幸存者中肌钙蛋白 I 水平无差异（p=0.260）。
在儿科急性心肌炎中，较低的 LVEF、升高的 BNP 以及低血压和心律失常的存在与需要重症监护有关。低血压和呕吐在非幸存者中更为常见。由于疾病可能迅速恶化，医生应警惕这些发现。
