Pediatric Patients Hospitalized with Myocarditis: A Multi-Institutional Analysis
Pediatric Patients Hospitalized with Myocarditis: A Multi-Institutional Analysis
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DOI：
10.1007/s00246-009-9589-9
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发表时间：
2010-02-01
影响因子：
1.6
通讯作者：
Slonim, Anthony D.
中科院分区：
文献类型：
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作者：
Klugman, Darren;Berger, John T.;Slonim, Anthony D.
这项研究的目的是确定住院的儿童心肌炎患者的患者、机构和利用特征与预后相关。这是一项非同步队列研究，研究对象是35家隶属于儿科健康信息系统(PHIS)的学术儿童医院的所有连续儿科出院患者：从2005年1月1日至2005年12月31日期间，参与医院出院的患者从出生到21岁。检查了患者水平、机构水平和利用变量。共有427,615名患者出院，其中216人(0.05%)被诊断为心肌炎。常见的病因是特发性(82%)，与其他疾病有关(6%)，以及细菌或病毒(3%)。心肌炎患者需要相当多的支持，包括静脉注射免疫球蛋白(49.1%)、米力农(45%)、肾上腺素(35%)、机械通气(25%)、体外膜氧合(7%)和心脏移植(5%)。即使在病情严重的患者中，静脉注射丙种球蛋白的使用也不会影响生存率(P=0.67)。心肌炎患者的总存活率为92%。死亡的心肌炎患者的病情严重程度更高，需要经常使用体外膜氧合和其他ICU治疗。总而言之，与其他诊断的儿童相比，患有心肌炎的儿童患者在他们的表现和结果上有相当大的变异性，使用更多的资源，死亡更频繁。使用统一预测疾病严重程度或存活率的特征的尝试没有成功。尽管在病情最严重的患者中增加了IVIG的使用，但IVIG并没有带来生存优势。
The objective of this study was to identify the patient, institutional, and utilization characteristics associated with outcome in hospitalized pediatric patients with myocarditis. This was a nonconcurrent cohort study of all consecutive pediatric discharges from the 35 academic children's hospitals that are members of the Pediatric Health Information System (PHIS): patients from birth through age 21 years discharged from participating hospitals between January 1, 2005, and December 31, 2005. Patient-level, institution-level, and utilization variables were examined. A total of 427,615 patients were discharged, and 216 (0.05%) were diagnosed with myocarditis. Common etiologies were idiopathic (82%), related to other diseases (6%), and bacterial or viral (3%). Myocarditis patients required considerable support including intravenous immunoglobulin (IVIG; 49.1%), milrinone (45%), epinephrine (35%), mechanical ventilation (25%), extracorporeal membrane oxygenation (7%), and cardiac transplantation (5%). Even in patients with extreme illness scores, IVIG use did not impact survival (P = 0.67). Overall survival of myocarditis patients was 92%. Myocarditis patients who died presented with a higher severity of illness and required frequent use of extracorporeal membrane oxygenation and other ICU therapies. In conclusion, pediatric patients with myocarditis have considerable variability in their presentations and outcomes, use more resources, and die more often than children with other diagnoses. Attempts at using characteristics that uniformly predict illness severity or survival were not successful. Despite increased use in the sickest patients, IVIG conferred no survival advantage.