Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2020; 8(22): 5547-5554
Published online Nov 26, 2020. doi: 10.12998/wjcc.v8.i22.5547
Risk factors analysis of prognosis of adult acute severe myocarditis
Qian Zhang, Rui Zhao
Qian Zhang, Rui Zhao, Department of Heart Center, Peking University People's Hospital, Beijing 100044, China
Author contributions: Zhang Q is responsible for patient information entry, statistical processing and article draft writing; Zhao R is responsible for proposing the concept of articles and reviewing articles.
Institutional review board statement: This study conforms to the Helsinki Declaration on Human Beings and has been approved by the Hospital Ethics Committee.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors confirm that there is no potential conflict of interest
Data sharing statement: There is no other data to declare. Anyone interested in the data in this article can obtain patient information (except patient privacy information) by sending an email to the correspondent’s mailbox.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qian Zhang, MD, Chief Doctor, Department of Heart Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China. pekinguniversityqian@bjmu.edu.cn
Received: June 4, 2020
Peer-review started: June 4, 2020
First decision: July 25, 2020
Revised: July 31, 2020
Accepted: September 16, 2020
Article in press: September 16, 2020
Published online: November 26, 2020
Processing time: 174 Days and 4.3 Hours
Abstract
BACKGROUND

Adult severe myocarditis is primarily caused by infection with any number of a variety of viruses. It arises quickly, progresses rapidly, and may lead to severe heart failure or circulatory failure presenting as rapid-onset hypotension and cardiogenic shock with a high hospital mortality rate.

AIM

To analyze the risk factors affecting the short-term prognosis of adult acute severe myocarditis (ASM).

METHODS

Adult patients with ASM (ASM group, n = 218) and acute nonsevere myocarditis (ANSM group, n = 80) who came to our department from January 2014 to January 2020 were enrolled in this study. Patients with ASM were divided into the ASM survival group (n = 185) and ASM nonsurvival group (n = 33) according to the treatment results during hospitalization. The clinical symptoms, laboratory examinations, treatment methods, complications, and the relationship between the treatment results of the two groups were retrospectively compared and discussed. The risk factors for death in patients with severe myocarditis were analyzed by binary logistic regression. A follow-up to 5.5 years was conducted on patients in the ASM survival group and ANSM group after discharge, and the readmission rate and incidence rate of dilated cardiomyopathy were analyzed.

RESULTS

Compared with the ASM survival group, the ASM nonsurvival group had longer QRS complex, higher incidence of cardiogenic shock, higher serum creatinine (SCr, 235μmol/L vs 89 μmol/L, P < 0.05), higher sensitive cardiac troponin I (cTnI, 4.45 μg/L vs 1.66 μg/L, P < 0.05) and brain natriuretic peptide (BNP, 1756 pg/mL vs 401 pg/mL, P < 0.05). The binary logistic regression revealed that there were statistical differences between the two groups in SCr, cTnI, and BNP values (all P < 0.05). After discharging from the hospital, patients in the ASM group and ANSM group had no significant differences in the readmission rate and incidence rate of dilated cardiomyopathy.

CONCLUSION

Elevated SCr, cTnI, and BNP are independent predictors for poor prognosis in patients with ASM. The long-term prognosis of patients in the ASM survival group is good.

Keywords: Acute severe myocarditis; Risk factor; Hospital mortality; Prognosis; Dilated cardiomyopathy

Core Tip: Elevated serum creatinine, sensitive troponin I, and brain natriuretic peptide are independent predictors for poor prognosis in patients with acute severe myocarditis.