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
ARTICLE HIGHLIGHTS
Research background

Adult acute severe myocarditis (ASM) is acute in onset and severe in condition with different clinical manifestations and prognosis. After regular treatment, most patients with ASM had a good prognosis, but a few patients died of cardiogenic shock and malignant arrhythmia. Some patients developed dilated cardiomyopathy, third-degree atrioventricular block, and chronic arrhythmia after discharge.

Research motivation

A way to effectively assist clinicians in grading the severity of myocarditis patients when they are admitted to the hospital is urgently needed.

Research objectives

This retrospective study aimed to find the related factors influencing the early prognosis and analyze the results of follow-up in adult patients with acute fulminant myocarditis.

Research methods

Adult patients with acute myocarditis who came to our department from January 2014 to January 2020 were enrolled in this study. They were divided into two groups according to the degree of illness. The clinical symptoms, laboratory examination, 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 acute nonsevere myocarditis group after discharge, and the readmission rate and incidence rate of dilated cardiomyopathy were analyzed.

Research results

A total of 265 patients, including 185 ASM and 80 acute nonsevere myocarditis patients were enrolled in our study. Of all the patients, 64.9% of patients (n = 172) were male with an average age of 39 ± 14-years-old. A total of 33 ASM patients (male, n = 20) died in the hospital with an average age of 40 ± 16-years-old. Compared with those in the survival group, the incidence of QRS wave duration, cardiac shock, serum creatinine (SCr) level, cardiac troponin I (cTnI) level, and brain natriuretic peptide (BNP) level significantly increased in the nonsurvival group. Furthermore, binary logistic regression analysis suggested that SCr, cTnI, and BNP levels were independently correlated with the prognosis in patients with fulminant myocarditis. No significant difference was found in the rehospitalization rate and the morbidity of dilated cardiomyopathy between the survival group and the nonsurvival group. In addition, adult patients with acute fulminant myocarditis discharged from the hospital have a good long-term prognosis.

Research conclusions

Increased SCr, cTnI, and BNP values are independent risk factors for poor prognosis of ASM patients. Clinicians can classify patients with myocarditis according to their SCr, cTnI, and BNP values when they are admitted to the hospital to make clear the severity of illness.

Research perspectives

So far, ASM developing to dilated cardiomyopathy is still unclear. Multicenter, large sample size, randomized controlled trials will be needed to explore the predictive value of various laboratory indicators on the prognosis of ASM.