Predictors for In-hospital Mortality in Pediatric Patients with Acute Myocarditis – a Retrospective Study

DOI: 10.2478/jce-2019-0019

Background: Acute myocarditis, a primary inflammatory cardiac disease commonly caused by viral infection, is an important cause of morbidity and mortality in children. Data obtained from forensic studies found an incidence of 15–33% for acute myocarditis in sudden deaths in the pediatric age group. Currently, there is a lack of data regarding the incidence and factors associ- ated with short-term outcomes in pediatric patients admitted for acute myocarditis. The aim of the study was to identify predictors for in-hospital mortality in a pediatric population admitted with acute myocarditis. Material and methods: We conducted a retrospective observational cohort study that included 21 patients admitted for acute myocarditis. Clinical, laboratory, ECG, and im- aging data acquired via 2D transthoracic echocardiography and cardiac magnetic resonance im- aging were collected from the medical charts of each included patient. The primary end-point of the study was all-cause mortality occurring during hospitalization (period ranging from 10 to 14 days). The study population was divided into 2 groups according to the occurrence of the primary end-point. Results: The mean age of the study population was 99.62 ± 77.25 months, and 61.90% (n = 13) of the patients were males. The in-hospital mortality rate was 23.9% (n = 5). Patients in the deceased group were significantly younger than the survivors (55.60 ± 56.18 months vs. 113.4 ± 78.50 months, p = 0.039). Patients that had deceased presented a significantly higher level of LDH (365 ± 21.38 U/L vs. 234.4 ± 63.30 U/L, p = 0.0002) and a significantly higher rate of ventricular ex- trasystolic dysrhythmias (60% vs. 6.25%, p = 0.02, OR: 22.5, 95% CI: 1.5–335) compared to survi- vors. The 2D echocardiography showed that patients that had deceased presented more frequently an impaired left ventricular ejection fraction (<30%) (p = 0.001) and a significantly higher rate of severe mitral regurgitation (p = 0.001) compared to survivors. Conclusions: The most powerful predictors for in-hospital mortality in pediatric patients admitted for acute myocarditis were the presence of ventricular extrasystolic dysrhythmias on the 24h Holter ECG monitoring, impaired left ventricular systolic function (LVEF <30%), the presence of severe mitral regurgitation, and confirmed infection with Mycoplasma pneumoniae.