Early clinical predictors of fulminant myocarditis in pediatric patients: a retrospective cohort study
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Published on: May 31, 2017
1Department of CICU, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China.
Insights
Early identification of fulminant myocarditis is crucial for timely treatment. Biomarkers such as N-terminal pro-B-type natriuretic peptide (NT-proBNP), cardiac troponin I (cTnI), alanine aminotransferase (ALT), and lactate (Lac) can predict its onset.
Area of Science:
- Cardiology
- Internal Medicine
- Biomarker Research
Background:
- Fulminant myocarditis is a severe cardiac condition requiring prompt diagnosis.
- Early identification is critical for improving patient outcomes and prognosis.
- Clinical indicators and laboratory markers can aid in the early detection of fulminant myocarditis.
Purpose of the Study:
- To identify clinical and laboratory indicators for the early detection of fulminant myocarditis.
- To evaluate the predictive value of specific biomarkers in diagnosing fulminant myocarditis.
- To compare patient characteristics between fulminant and non-fulminant myocarditis groups.
Main Methods:
- Retrospective analysis of 269 acute myocarditis patients (2014-2023).
- Division into fulminant (n=40) and non-fulminant (n=229) groups for comparison.
- Multifactorial analysis and Receiver Operating Characteristic (ROC) curve analysis to identify predictive factors.
Main Results:
- Older age was associated with fulminant myocarditis (P=0.015).
- Fever and hypotension were more frequent in the fulminant group (P<0.05).
- N-terminal pro-B-type natriuretic peptide (NT-proBNP), lactate (Lac), alanine aminotransferase (ALT), and cardiac troponin I (cTnI) were identified as early risk factors.
Conclusions:
- NT-proBNP, cTnI, ALT, and Lac are significant predictors for early diagnosis of fulminant myocarditis.
- Optimal predictive values established for NT-proBNP (2,783.5 pg/ml), ALT (34.5 U/L), cTnI (0.2 µg/ml), and Lac (3.05 mmol/L).
- Early identification and diagnosis are vital for improving patient prognosis in fulminant myocarditis.
Objective:
Various clinical indicators can increase the likelihood of early identification of fulminant myocarditis, the identification of which is important for early treatment.
Method:
The medical records of all patients (n = 269) who were diagnosed with acute myocarditis between January 2014 and December 2023 were retrospectively analyzed. Patients were divided into two groups: the nonfulminant myocarditis group (n = 229) and the fulminant myocarditis group (n = 40). Baseline demographics, laboratory findings, electrocardiograms, echocardiograms, and treatment regimens were compared between the two groups via multifactorial analysis. A receiver operating characteristic (ROC) curve was used to explore the predictive value of related factors.
Results:
The median age of patients with fulminant myocarditis was significantly greater than that in the nonfulminant group (P = 0.015). The presenting symptoms at admission varied and included fever and respiratory, digestive, and circulatory symptoms. Among them, fever and hypotension were more common in the fulminant myocarditis group (P < 0.05), and vomiting was significantly more common in the nonfulminant myocarditis group (P = 0.017). Logistic regression analysis revealed that N-terminal pro-B-type natriuretic peptide (NT-proBNP), lactate (Lac), alanine aminotransferase (ALT), cardiac troponin I (cTnI), chest distress, and hypotension were early risk factors for fulminant myocarditis. ROC curve analysis demonstrated that NT-proBNP, ALT, cTnI, and Lac can serve as predictors for the early diagnosis of fulminant myocarditis. The optimal predictive values for these markers are 2,783.5 pg/ml for NT-pro BNP, 34.5 U/L for ALT, 0.2 µg/ml for cTnI, and 3.05 mmol/L for Lac.
Conclusions:
This study revealed that NT-proBNP, cTnI, ALT, and Lac can serve as predictive factors for the early identification of fulminant myocarditis. These findings emphasize the importance of early identification and timely diagnosis for improving the overall prognosis of patients.
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