Clinical features and risk factors of fulminant myocarditis in children
Objective To investigate the early clinical features and risk factors of fulminant myocarditis in children,and to provide clinical experience for the early identification of fulminant myocarditis.Methods The clinical data of 51 children with fulminant myocarditis and 62 children with acute myocarditis admitted to the Children's Hospital of Chongqing Medical University from January 2015 to January 2022 were retrospectively analyzed.Results(1)The age at the onset of the disease in the fulminant myocarditis group was older,with the incidence of Asian seizures,dizziness,headache,dyspnea,nausea,vomiting,abdominal pain,bloating,oliguria,altered consciousness,low heart sounds,irregular heartbeat,cold extremities,facial changes,and liver enlargement being greater than that in the acute myocarditis group(P＜0.05).(2)Compared with the acute myocarditis group,white blood cell count,C-reactive protein,hypertroponin I,creatine kinase isoenzyme MB type,lactate dehydrogenase,alanine aminotransferase,aspartate aminotransferase,blood creatinine,blood urea nitrogen,albumin,left heart function,cardial enlargement ventricular septum,wall mobility and thickness,pericardial effusion,moderate and severe regurgitation of the ditricuspid valve,ventricular tachycardia,escape beat,ventricular fibrillation/ventricular arrest,third-degree atrioventricular block,and bundle branch block in the fulminant myocarditis group had significant differences(P＜0.05),but there was no significant difference in the detection rate of various etiologies between the two groups(P＞0.05).(3)Logistic regression analysis showed that albumin,left ventricular ejection fraction,third-degree atrioventricular block,and bundle branch block were predictive risk factors for fulminant myocarditis;Logistic regression equation P=1/[1+e-(92.862-0.171×ALB-0.351×LVEF+6.286×Ⅲ°alrioventrieular block+5.492×bundle branch block)],sensitivity was 94.1％and specificity was 96.8％,with good discrimination.(4)Children with fulminant myocarditis were given comprehensive treatment such as immune regulation,anti-arrhythmia,anti-heart failure,and anti-infection,and 3 children(5.8％)died.Conclusion The clinical manifestations of fulminant myocarditis in children are atypical,with low albumin in the early stage,decreased left ejection fraction,third-degree atrioventricular block and bundle branch block being predictive risk factors for fulminant myocarditis.
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