Clinical characteristics and mortality risk prediction model in children with acute myocarditis

Abstract

Background Acute myocarditis (AMC) can cause poor outcomes or even death in children. We aimed to identify AMC risk factors and create a mortality prediction model for AMC in children at hospital admission. Methods This was a single-center retrospective cohort study of AMC children hospitalized between January 2016 and January 2020. The demographics, clinical examinations, types of AMC, and laboratory results were collected at hospital admission. In-hospital survival or death was documented. Clinical characteristics associated with death were evaluated. Results Among 67 children, 51 survived, and 16 died. The most common symptom was digestive disorder (67.2%). Based on the Bayesian model averaging and Hosmer–Lemeshow test, we created a final best mortality prediction model (acute myocarditis death risk score, AMCDRS) that included ten variables (male sex, fever, congestive heart failure, left-ventricular ejection fraction < 50%, pulmonary edema, ventricular tachycardia, lactic acid value > 4, fulminant myocarditis, abnormal creatine kinase-MB, and hypotension). Despite differences in the characteristics of the validation cohort, the model discrimination was only marginally lower, with an AUC of 0.781 (95% confidence interval = 0.675–0.852) compared with the derivation cohort. Model calibration likewise indicated acceptable fit (Hosmer‒Lemeshow goodness-of-fit, P¼ = 0.10). Conclusions Multiple factors were associated with increased mortality in children with AMC. The prediction model AMCDRS might be used at hospital admission to accurately identify AMC in children who are at an increased risk of death.

A Retrospective Analysis of Clinical Characteristics and Outcomes of Pediatric Fulminant Myocarditis

“…In our center, we found that AFM was more prevalent in females than in males among children, which is inconsistent with the results of two previous studies [23,24], but in alignment with the results reported by Shanghai Children's Medical Center [25]. Pediatric AFM can be non-speci c, commonly symptomized by vomiting, fever, abdominal pain, and chest tightness.…”

“…Some children also present with syncope, poor appetite, coughing, dizziness, shortness of breath, headache, edema, pallor, discomfort in the precordial area, coma, drowsiness, sudden respiratory and cardiac arrest, diarrhea, etc. Besides, AFM may simultaneously involve multiple systems, like the digestive, nervous, and respiratory systems [24].…”

Establishment and validation of a prediction model for myocarditis in Chinese children below 14 years old: a protocol for a retrospective cohort study

“…To identify reliable predictors and address collinearity among independent variables, we will employ the LASSO regression analysis 24. As the outcome event pertains to myocarditis development in children, we will use multiple logistic regression analyses18 25–29 to construct an early prediction model for myocarditis. This model estimates the probability of myocarditis by assessing the child’s condition during a visit.…”