Could the unfortunate outcome of pediatric acute myocarditis be predicted? Factors contributing to a poor outcome in myocarditis; [Poderemos prever o mau prognóstico da miocardite aguda em idade pediátrica? Fatores determinantes de prognóstico adverso]

Krasic, Stasa (57192096021)Stasa (57192096021)KrasicPrijic, Sergej (20734985500)Sergej (20734985500)PrijicNinic, Sanja (51864038300)Sanja (51864038300)NinicNesic, Dejan (26023585700)Dejan (26023585700)NesicBjelakovic, Bojko (15070010000)Bojko (15070010000)BjelakovicPetrovic, Gordana (57211071996)Gordana (57211071996)PetrovicCerovic, Ivana (57220213990)Ivana (57220213990)CerovicVukomanovic, Vladislav (55881072000)Vladislav (55881072000)Vukomanovic2025-06-122025-06-122021https://doi.org/10.1016/j.repc.2020.10.015https://www.scopus.com/inward/record.uri?eid=2-s2.0-85108577978&doi=10.1016%2fj.repc.2020.10.015&partnerID=40&md5=95cef1646cf5a854382b20362b366cd0https://remedy.med.bg.ac.rs/handle/123456789/4117Objective: Myocarditis has spontaneous resolution in 50% of patients. Our study aimed to define risk factors for developing dilated cardiomyopathy (DCM) and death in pediatric patients with acute myocarditis (AM). Methods: The retrospective cohort study included all patients with treated AM. The Mother and Child Health Institute from January 2011 to March 2019. Results: In the study, 62 patients were included, 40 boys and 22 girls (11.15±5.86 years) with AM. Twelve out of sixty-two children had acute fulminant myocarditis. Four patients died in the acute phase of AM, and 11 developed DCM. Follow up was 27.14±36.52 months. Patients with poor outcome (DCM development) were under the age of seven (odds ratio [OR] 10.1; p=0.003), more likely to be girls (OR 4.6; p=0.03), and had fulminant myocarditis (OR 27.0; <0.001). An ejection fraction (EF) <55% and fractional shortening (FS) <30% increased risk of DCM 13- and 5-fold, respectively, but patients with EF between 40 and 55% remain at highest risk of developing DCM. There was a 12-fold increased risk for DCM in patients with left ventricular end-diastolic diameter Z score >2+. The receiver operator curve showed that the lactate dehydrogenase (LDH) cut-off value for developing DCM was 1780 mmol/l (sensitivity 80%, specificity 100%). Conclusion: Acute fulminant myocarditis was an independent risk factor for DCM. Children with EF between 40 and 50% at admission were at highest risk of developing DCM. Lactate dehydrogenase value could be a significant prognostic value for the outcome of pediatric myocarditis. © 2021 Sociedade Portuguesa de CardiologiaDeathDilated cardiomyopathyMyocarditisOutcomesPediatricCould the unfortunate outcome of pediatric acute myocarditis be predicted? Factors contributing to a poor outcome in myocarditis; [Poderemos prever o mau prognóstico da miocardite aguda em idade pediátrica? Fatores determinantes de prognóstico adverso]