Predictors of Mortality in Paediatric Myocarditis
Introduction: Paediatric myocarditis can present as mild flu like symptoms to fulminent form. Early identification of the severity of illness and prioritization of intensive care is helpful especially in developing countries with limited resources. Aim: To know the factors at admission that can...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2016-06-01
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| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://jcdr.net/articles/PDF/7967/19856_CE(RA1)_F(T)_PF1(ROAK)_PFA(AK)_PF2(PAG).pdf |
| Summary: | Introduction: Paediatric myocarditis can present as mild flu like
symptoms to fulminent form. Early identification of the severity
of illness and prioritization of intensive care is helpful especially
in developing countries with limited resources.
Aim: To know the factors at admission that can predict mortality
in paediatric myocarditis.
Materials and Methods: This was an observational study
which enrolled children who presented with fever of acute
onset (less than 15 days in duration), and were diagnosed as
suspected myocarditis on the basis of clinical features, Troponin
I and echocardiography, according to Expanded criteria for
myocarditis in Paediatric ward at our institute over a period from
August 2014 to December 2015. Their clinical features, cardiac
biomarkers and echocardiography findings were compared
between survivors and non-survivors.
Statistical Analysis: All statistical analysis was done using
graphpad Prism 5 and SPSS statistical software. A Fisher exact
p-value <0.05 was regarded as significant. Multivariate Logistic
Regression was carried out to quantify the relationship between
cardiac death and other predictor variables. The logistic
coefficients for the predictor variables and their exponents, that
is, log odds were calculated. Statistical significance of these
predictor variables was interpreted by p-values.
Results: A 17.7% (n=11/62) patients of paediatric myocarditis
died in this study. New York Heart Association (NYHA) class IV
dyspnea (p=0.0115) and hypotension (p=0.0174) were more in
patients who did not survive. The mean value of Troponin I was
more in the non-survivor group (0.958 ± 1.13ng/ml); (p=0.0074).
More number of patients who died had Brain Natriuretic Peptide
(BNP) levels increased in their plasma (p=0.0087) with higher
mean value (p=0.0175). LV ejection fraction was decreased
markedly in non survivor group with mean value of 37±8.09 %
as compared to survivor group with mean value of 46.6±10.5%,
(p=0.0115). On multivariate analysis, NYHA class IV dyspnea
(p=0.0113), BNP (p=0.015) and ejection fraction (p = 0.0284)
independently are the predictors of mortality in our study
group.
Conclusion: Children with myocarditis having hypotension,
raised Troponin I, BNP and decreased ejection fraction are
more prone to die. NYHA IV dyspnea, higher levels of BNP and
decreased EF are independently related to worst outcome. |
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| ISSN: | 2249-782X 0973-709X |