Diagnostic Yield of Cardiac Biomarker Testing in Predicting Cardiac Disease and Multisystem Inflammatory Syndrome in Children in the Pandemic Era.
Diagnostic Yield of Cardiac Biomarker Testing in Predicting Cardiac Disease and Multisystem Inflammatory Syndrome in Children in the Pandemic Era.
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DOI：
10.1097/pec.0000000000002804
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发表时间：
2022-10-01
影响因子：
1.4
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中科院分区：
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这项研究旨在评估心脏生物标志物的升高是否与新冠肺炎时代的儿科心脏诊断和儿童多系统炎症综合征(MSC)相关。这项单中心的回顾性研究分析了2020年4月21日至12月31日期间在急诊科或住院病房发现肌钙蛋白的儿童。主要结果是存在心脏诊断或MISC。分析人口统计学、主诉、心脏诊断和心脏生物标志物之间的关系。486例患者(平均年龄13.1±7.8岁，女性占46.7%)符合纳入标准，其中27例(5.6%)患者被诊断为心脏病(不包括管理信息系统C)，14例(2.9%)被诊断为管理信息系统C。初始高敏感性肌钙蛋白T升高(&gT；14 ng/L)预测心脏诊断或MISC的综合结果的敏感性和特异性分别为54%和89%。在肌钙蛋白初始值为阴性的患者中，有4%的患者被发现有心脏诊断或MI-C。多因素回归分析显示，hsTropT升高(&gT；14 ng/L；优势比[OR][95%可信区间]：4.9[1.70-14.0])和N末端B型利钠肽原水平升高(&gT；500 pg/mL；6.4[2.01-20.1])与心脏诊断或MISC的风险增加相关。心脏生物标志物升高的儿童心脏病诊断或MISC的几率增加，无论检测适应症如何，都需要进行体检。尽管hsTropT阴性可能会让提供者放心，但进一步的研究对于开发可靠地排除心脏病的算法至关重要。
This study aimed to assess whether elevations in cardiac biomarkers are associated with pediatric cardiac diagnoses in the era of COVID-19 and multisystem inflammatory syndrome in children (MIS-C). This single-center retrospective study analyzed children with a troponin drawn in the emergency department or inpatient unit between April 21 and December 31, 2020. The primary outcome was the presence of a cardiac diagnosis or MIS-C. Relationships among demographics, complaint, cardiac diagnostics, and cardiac biomarkers were analyzed. Four hundred eighty-six patients (mean ± SD; age 13.1 ± 7.8 years; 46.7% women) met inclusion criteria, for whom a cardiac diagnosis (excluding MIS-C) was made in 27 (5.6%) patients, with MIS-C diagnosed in 14 (2.9%) patients. The sensitivity and specificity of an elevated initial high-sensitivity troponin T (hsTropT) value (>14 ng/L) in predicting the composite outcome of a cardiac diagnosis or MIS-C were 54% and 89%, respectively. Four percent of patients with negative initial troponin values were found to have a cardiac diagnosis or MIS-C. Multivariable regression analysis demonstrated that elevated hsTropT (>14 ng/L; odds ratio [OR] [95% confidence interval]: 4.9 [1.70–14.0]) and elevated N-terminal pro B-type natriuretic peptide values (>500 pg/mL; 6.4 [2.01–20.1]) were associated with increased odds of a cardiac diagnosis or MIS-C. Children with elevated cardiac biomarkers have increased odds of a cardiac diagnosis or MIS-C and warrant workup regardless of indication for testing. Although a negative hsTropT may reassure providers, further investigation is critical in developing algorithms to reliably exclude cardiac disease.