Analysis Of Clinical Features Of Fulminant Myocarditis In Children

Purposes1.To investigate the risk factors of pediatric fulminant myocarditis by retrospectively analyzing the clinical manifestations,laboratory test indexes and imaging findings of common myocarditis and fulminant myocarditis in children.2.To compare the clinical data of ECMO group and non-ECMO group in children with fulminant myocarditis,and to find the risk factors for ECMO treatment.3.To compare and analyze the data of the survival and death groups of children with fulminant myocarditis in the ECMO group to find the factors of prognosis of fulminant myocarditis treated by ECMO.MethodRetrospective analysis of 32 children diagnosed with fulminant myocarditis during hospitalization in PICU from December 2017 to February 2022 in our hospital was performed as a case group.At the same time,32 children with common myocarditis who were hospitalized in the general ward were collected as the control group,and the clinical symptoms and laboratory indexes,electrocardiogram and cardiac ultrasound results of children in both groups were analyzed,while the laboratory indexes of children who underwent extracorporeal membrane oxygenation(ECMO)treatment within the fulminant myocarditis group were We also analyzed the laboratory parameters of children treated with ECMO in the fulminant myocarditis group to find the factors affecting ECMO treatment.The children treated with ECMO were divided into survival and death groups to find the factors affecting the poor prognosis of the children treated with ECMO.SPSS26.0 was used for statistical analysis,and differences were considered statistically significant at P < 0.05.The statistically significant correlated factors were analyzed by Logistic regression,and the Receiver operator characteristic curve(ROC)was plotted to investigate the independent risk factors for fulminant myocarditis and factors affecting ECMO treatment.Result1.The prodromal symptoms in the case group were mainly extrathoracic,mainly manifested as abdominal pain and diarrhea(65.6%),while in the control group,the discomfort in the anterior chest region was mainly manifested as chest tightness and chest pain(59.4%);the serum pathogenic antibody tests in both the case and control groups indicated that mycoplasma infection was the main cause.2.The cardiac enzymes in the case group were significantly higher than those in the control group,while the platelet level was significantly lower than that in the common myocarditis group,and the differences were statistically significant(P<0.05).3.The ECG arrhythmias in the case group were mainly atrioventricular block,while the ECG arrhythmias in the control group were mainly sinus tachycardia;the number of children with total heart enlargement,reduced systolic function,reduced ventricular wall function and pericardial effusion was significantly higher in the case group than in the control group,and the differences were statistically significant;multifactorial logistic regression analysis showed that abdominal pain and diarrhea,convulsions and third-degree atrioventricular block were independent risk factors for fulminant myocarditis.4.Within the case group,the length of stay and ejection fraction(EF)values were significantly lower in the death group compared with the survival group,and the D-dimer(D-D)was significantly higher in the death group than in the survival group,with statistically significant differences(P<0.05).logistic regression showed that reduced EF was a risk factor affecting the development of fulminant myocarditis The area under the D-D curve was 0.749(95% CI=0.575-0.923),and the cutoff value obtained by calculating the Yordon index was 9.875 mg/L,with a sensitivity of 72.7 and specificity of 71.4;the area under the EF curve was 0.838(95% CI=0.699-0.977),and the cutoff value obtained by calculating the Yordon index was36.5 %,The sensitivity was 90.9 and the specificity was 76.2.5.Comparing the ECMO group with the non-ECMO group within the case group,total bilirubin,glutamic oxalacetic transaminase,glutamic alanine transaminase,creatine kinase,creatine kinase isoenzyme,myoglobin and troponin were significantly higher in the ECMO group than in the non-ECMO group,and the EF value and platelet level were significantly lower than in the non-ECMO group,with statistically significant differences(P<0.05).The logistic regression analysis of ECMO treatment showed that the total bilirubin level was a risk factor for ECMO treatment in children.6.The difference was statistically significant(P<0.05)between the survival group and the death group.logistic regression showed that reduced EF was a risk factor for poor prognosis in patients with fulminant myocarditis treated with ECMO.area under the curve of 0.791(95% CI=0.590-0.992),and calculation of the Jorden index yielded a cutoff value of 41%,a sensitivity of 100.0,and a specificity of 54.5.Conclusions:1.fulminant myocarditis has a prodromal infection and no specific clinical symptoms,mostly extrathoracic manifestations,such as digestive system and neurological system,which can easily lead to missed diagnosis and misdiagnosis.2.Decreased EF is a risk factor for poor prognosis in children with fulminant myocarditis.Total bilirubin is an independent risk factor for ECMO treatment.3.EF values in the survival group of the fulminant myocarditis ECMO group were significantly higher than those in the death group,and reduced EF values were a risk factor for poor prognosis after ECMO treatment.