中低收入国家一家三级保健医院收治的登革热感染患者中心肌炎的患病率和结局。
Prevalence and Outcomes of Myocarditis in Dengue-Infected Patients Admitted to a Tertiary Care Hospital of Low-Middle Income Country.
机构信息
Aga Khan University Hospital, PK.
出版信息
Glob Heart. 2022 Jun 23;17(1):44. doi: 10.5334/gh.1129. eCollection 2022.
BACKGROUND
Myocarditis is a challenging diagnosis due to the heterogeneity of clinical presentations. Myocarditis can present with a mildly raised cardiac enzyme to severe myocarditis leading to congestive heart failure, arrhythmias, cardiogenic shock, and death. It is a predictor of morbidity and mortality in dengue-infected patients. The exact prevalence of dengue myocarditis and its outcomes are unknown in Pakistan.
OBJECTIVES
We aim to study the prevalence and association of myocarditis with the length of stay in the hospital and mortality of dengue-infected patients.
METHODS
A retrospective observational study done at a tertiary care hospital. We reviewed hospital record files of 1008 consecutive patients with dengue viral infection admitted from November 2018 to November 2019.
RESULTS
Out of 1008 dengue-infected patients, 55.4% of patients were older than 35 years and 68.4% were males. Hypertension (HTN) was the most common comorbid condition. The prevalence of myocarditis in hospitalized dengue-infected patients was 4.2%. All (100%) of dengue myocarditis patients had raised cardiac troponin I (cTn-I), 59.5% of patients had at least one electrocardiography (ECG) change, and 24% had reduced ejection fraction (EF) (defined as EF < 55%). On multivariable analysis, patients with raised cTn-I levels (adjusted odds ratios = 5.29; [95% confidence interval (CI): 2.16-12.96]) and abnormal echocardiography (ECHO) [aOR = 4.38; 95% CI: 1.26-15.27)] had a prolonged hospital stay (>3 days). Raised cTn-I levels (aOR = 8.2; [95% CI: 1.83-36.84]) was significantly associated with in-hospital mortality.
CONCLUSIONS
Raised cTn-I is the predictor of length of stay and in-hospital mortality in dengue-infected patients. Atrial fibrillation, diabetes mellitus, hypertension, low serum bicarbonate, high serum creatinine, and any abnormality on echocardiography were associated with adverse outcomes in dengue-infected patients.
背景
心肌炎的临床表现具有异质性，因此诊断具有挑战性。心肌炎的临床表现从轻度心肌酶升高到严重心肌炎导致充血性心力衰竭、心律失常、心源性休克和死亡不等。它是登革热感染患者发病率和死亡率的预测因素。在巴基斯坦，登革热心肌炎的确切患病率及其结局尚不清楚。
目的
我们旨在研究心肌炎与登革热感染患者住院时间和死亡率的相关性及其患病率。
方法
这是一项在三级保健医院进行的回顾性观察性研究。我们回顾了 2018 年 11 月至 2019 年 11 月期间收治的 1008 例连续登革热病毒感染患者的住院病历档案。
结果
在 1008 例登革热感染患者中，55.4%的患者年龄大于 35 岁，68.4%的患者为男性。高血压（HTN）是最常见的合并症。住院登革热感染患者中心肌炎的患病率为 4.2%。所有（100%）登革热心肌炎患者的心肌钙蛋白 I（cTn-I）升高，59.5%的患者至少有一次心电图（ECG）改变，24%的患者射血分数（EF）降低（定义为 EF<55%）。多变量分析显示，cTn-I 水平升高（调整后的优势比=5.29；95%置信区间[CI]：2.16-12.96]）和超声心动图异常（aOR=4.38；95%CI：1.26-15.27）的患者住院时间延长（>3 天）。cTn-I 水平升高（aOR=8.2；95%CI：1.83-36.84）与登革热感染患者住院期间死亡显著相关。
结论
cTn-I 升高是登革热感染患者住院时间和住院期间死亡率的预测指标。房颤、糖尿病、高血压、低血清碳酸氢盐、高血清肌酐和超声心动图任何异常与登革热感染患者的不良结局相关。
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