Analysis of risk factors for in-hospital death of adult patients with acute fulminant myocarditis
陈永增 1韩静 1孟帅 1秦政 1金泽宁1
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作者信息
1. 1000710 首都医科大学附属北京天坛医院 心脏及大血管病中心
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摘要
目的:通过分析成人急性暴发性心肌炎(acute fulminant myocarditis,AFM)患者的临床特征和治疗结局,探究其院内死亡相关的风险因素.方法:通过对2008年1月至2022年12月,首都医科大学附属北京天坛医院收治的成人AFM患者进行回顾性研究,对比院内死亡患者与存活患者的人群特征、临床表现、治疗和结局,分析AFM患者院内死亡的相关危险因素.结果:共有91例患者符合AFM标准,并纳入了该研究,其中院内死亡者31例(34.1％),存活并出院者60例(65.9％).与存活者相比,院内死亡患者出现胸痛、多器官衰竭(multiple organ failure,MOF)和ST段抬高比例明显增多,收缩压和舒张压明显降低,LVEF降低,乳酸水平升高,且需要心肺复苏、主动脉内球囊反搏支持和机械通气的更大可能性更大(P＜0.05).上述10个因素也是单因素Logistic回归分析中院内死亡的预测因素,而多变量分析显示胸痛(OR=18.06,95％ CI:1.47～221.81)、低收缩压(OR=0.94,95％ CI:10.86～0.99)、入院时高水平的乳酸(OR=1.99,95％ CI:11.14～3.46)是成人AFM患者院内死亡的主要危险因素.结论:住院期间死亡的成年AFM患者的特征是胸痛、ST段抬高、血压和LVEF降低、入院时乳酸水平升高,入院时胸痛、收缩压降低和乳酸水平升高可能提示患者住院死亡的风险升高.
Abstract
Objective:We sought to describe the clinical characteristics and in-hospital outcomes of adult patients with acute fulminant myocarditis(AFM)and to identify the risk factors associated with in-hospital death.Methods:A retrospective study was performed with adult Chinese AFM patients admitted to our department between January 2008 and December 2022.The patients'demographics,clinical manifestations,therapies received,and in-hospital outcomes were investigated.We compared the clinical characteristics and outcomes of patients who died in hospital and those who survived to discharge.Results:A total of 91 patients met the criteria for AFM and were enrolled in the study.There were 31(34.1％)patients who died in hospital,and 60(65.9％)were discharged.When compared to the survivors,patients who died in hospital had higher incidences of chest pain,multiple organ failure(MOF)and ST-segment elevation,lower systolic and diastolic blood pressure,lower LVEF,higher levels of lactate,and greater possibilities of needing cardiopulmonary resuscitation,intra-aortic balloon pump support and mechanical ventilation(P＜0.05 for all).The above 10 factors are also predictors of in-hospital death in univariate logistic regression analysis,while multivariate analysis showed that chest pain(OR=18.06,95％ CI:1.47-221.81),low systolic blood pressure(OR=0.94,95％CI:0.86-0.99)and high levels of lactate(OR=1.99,95％ CI:1,14-3,46)on admission were main risk factors for in-hospital death in adult patients with AFM.Conclusions:Adult patients with AFM who died during hospitalization were characterized by manifestations of chest pain,ST-segment elevation,lower blood pressure and LVEF and higher levels of lactate on admission.The chest pain,lower systolic blood pressure and higher level of lactate on admission indicate a patient with a high risk of in-hospital death.
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