Clinical Findings and Predictors of Poor Outcome in Pediatric Viral Myocarditis Open Access

Garza, Nina Hirsch (2016)

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Background: Myocarditis is an important cause of cardiovascular morbidity and mortality in children. This study sought to characterize the clinical parameters of children diagnosed with viral myocarditis, determine which characteristics were associated with poor outcome, as well as develop a predictive model for poor outcome in this population.

Methods: A retrospective cohort was built from patients admitted with the diagnosis of acute myocarditis, septic myocarditis, or other unspecified myocarditis at Children's Hospital of Atlanta between January 2008 and December 2014. A total of 36 patients were included. Poor outcome was defined as in-hospital death or cardiac transplant. Univariate analysis was performed with assess risk between the groups. Stepwise logistic regression model selection was performed using variables collected at admission and during hospital course.

Results: In hospital mortality was 8.3%, with 17% experiencing poor outcome. Poor outcome was significantly associated in univariate analyses with low baseline ejection fraction (<30), positive viral titers, utilization of dopamine during hospitalization, and mechanical ventilation. Multivariable model selection for prediction of poor outcome identified peak CRP, admission diastolic blood pressure, baseline ESR, and symptomatic emesis as significant.

Discussion: While there appear to be some factors that significantly contribute to the development of poor outcome in children presenting with symptomatic viral myocarditis, multivariate modeling did not yield a robust set using this data. Future multicenter studies should be undertaken with larger sample sizes to more clearly elucidate meaningful predictors.

Table of Contents

Background 1

Methods 3

Results 5

Discussion 11

References 20

Tables 23

Figure 27

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