A Risk Prediction Model for In-hospital Mortality in Patients with Suspected Myocarditis

Abstract

Background:Myocarditis is an inflammatory disease of the myocardium that may lead to cardiac death in some patients. However, little is known about the predictors of in-hospital mortality in patients with suspected myocarditis. Thus, the aim of this study was to identify the independent risk factors for in-hospital mortality in patients with suspected myocarditis by establishing a risk prediction model.Methods:A retrospective study was performed to analyze the clinical medical records of 403 consecutive patients with suspected myocarditis who were admitted to Ningbo First Hospital between January 2003 and December 2013. A total of 238 males (59%) and 165 females (41%) were enrolled in this study. We divided the above patients into two subgroups (survival and nonsurvival), according to their clinical in-hospital outcomes. To maximize the effectiveness of the prediction model, we first identified the potential risk factors for in-hospital mortality among patients with suspected myocarditis, based on data pertaining to previously established risk factors and basic patient characteristics. We subsequently established a regression model for predicting in-hospital mortality using univariate and multivariate logistic regression analyses. Finally, we identified the independent risk factors for in-hospital mortality using our risk prediction model.Results:The following prediction model for in-hospital mortality in patients with suspected myocarditis, including creatinine clearance rate (Ccr), age, ventricular tachycardia (VT), New York Heart Association (NYHA) classification, gender and cardiac troponin T (cTnT), was established in the study: P = ea/(1 + ea) (where e is the exponential function, P is the probability of in-hospital death, and a = −7.34 + 2.99 × [Ccr <60 ml/min = 1, Ccr ≥60 ml/min = 0] + 2.01 × [age ≥50 years = 1, age <50 years = 0] + 1.93 × [VT = 1, no VT = 0] + 1.39 × [NYHA ≥3 = 1, NYHA <3 = 0] + 1.25 × [male = 1, female = 0] + 1.13 × [cTnT ≥50 μg/L = 1, cTnT <50 μg/L = 0]). The area under the receiver operating characteristic curve was 0.96 (standard error = 0.015, 95% confidence interval [CI]: 0.93-0.99). The model demonstrated that a Ccr <60 ml/min (odds ratio [OR] = 19.94, 95% CI: 5.66–70.26), an age ≥50 years (OR = 7.43, 95% CI: 2.18–25.34), VT (OR = 6.89, 95% CI: 1.86–25.44), a NYHA classification ≥3 (OR = 4.03, 95% CI: 1.13–14.32), male gender (OR = 3.48, 95% CI: 0.99–12.20), and a cTnT level ≥50 μg/L (OR = 3.10, 95% CI: 0.91–10.62) were the independent risk factors for in-hospital mortality.Conclusions:A Ccr <60 ml/min, an age ≥50 years, VT, an NYHA classification ≥3, male gender, and a cTnT level ≥50 μg/L were the independent risk factors resulting from the prediction model for in-hospital mortality in patients with suspected myocarditis. In addition, sufficient life support during the early stage of the disease might improve the prognoses of patients with suspected myocarditis with multiple risk factors for in-hospital mortality.

Myocarditis in the pediatric population: A review

“…Moreover, a study in the pediatric population demonstrated that children with myocarditis having hypotension, elevated Troponin I, brain natriuretic peptide, and decreased ejection fraction have higher mortality and the findings of NYHA class IV dyspnea, higher levels of brain natriuretic peptide and decreased ejection fraction are independently related to worse outcomes . This is similar to a study in the adult population which suggested that a creatinine clearance <60 mL/min, an age ≥50 years, ventricular tachycardia, an NYHA classification ≥3, male gender, and a Troponin T ≥50 μg/L were independent risk factors for in‐hospital mortality . These variable findings underscore the difficulty in assessing the long‐term outcomes of pediatric myocarditis after various therapies.…”

“…85 This is similar to a study in the adult population which suggested that a creatinine clearance <60 mL/min, an age ≥50 years, ventricular tachycardia, an NYHA classification ≥3, male gender, and a Troponin T ≥50 μg/L were independent risk factors for in-hospital mortality. 86 These variable findings underscore the difficulty in assessing the long-term outcomes of pediatric myocarditis after various therapies. Further studies with a robust, prolonged follow-up is required to accurately characterize patient characteristics and treatment modalities which may affect long-term outcomes.…”

Prevalence and Outcomes of Myocarditis in Dengue-Infected Patients Admitted to a Tertiary Care Hospital of Low-Middle Income Country

“…Additionally, the Tei index has also been evaluated in dengue myocarditis and it is of value in detecting patients with asymptomatic myocarditis not otherwise detected by conventional EF measurements [18]. Prognostic outcomes in myocarditis due to any reason include gender, cardiac enzymes level, NYHA class, and creatinine clearance or incidence of acute kidney injury [19]. Dengue myocarditis is a rare but possibly fatal condition.…”

“…Prognostic outcomes in myocarditis due to any reason include gender, cardiac enzymes level, NYHA class, and creatinine clearance or incidence of acute kidney injury [ 19 ]. Dengue myocarditis is a rare but possibly fatal condition.…”

Symptomatic Young Adults with ST-Segment Elevation—Acute Coronary Syndrome or Myocarditis: The Three-Factor Diagnostic Model

“…Serum cardiac biomarkers are routinely measured in patients presenting with chest pain in ED. Troponin is released into circulation from the damaged myocardium and is widely used as an indicator of the degree of myocardial injury [36]. In the case of myocarditis, cardiac serum enzymes are usually abnormal but there is an atypical release pattern.…”