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Clinical characteristics and mortality risk prediction model in children with acute myocarditis

World Journal of Pediatrics 2023年第2期19卷 180-188页

作者： Shi-Xin Zhuang Peng Shi Han Gao Quan-Nan Zhuang Guo-Ying Huang Children’s Hospital of Fudan University 399 Wan Yuan RoadShanghai201102China Pediatric Clinical Research Unit Department of Research ManagementChildren’s Hospital of Fudan UniversityShanghaiChina

Background Acute myocarditis(AMC)can cause poor outcomes or even death in children.We aimed to identify AMC risk factors and create a mortality prediction model for AMC in children at hospital admission.Methods This was a single-center retrospective cohort study of AMC children hospitalized between January 2016 and January 2020.The demographics,clinical examinations,types of AMC,and laboratory results were collected at hospital admission.In-hospital survival or death was documented.Clinical characteristics associated with death were evaluated.Results Among 67 children,51 survived,and 16 died.The most common symptom was digestive disorder(67.2%).Based on the Bayesian model averaging and hosmer–lemeshow test,we created a final best mortality prediction model(acute myocarditis death risk score,AMCDRS)that included ten variables(male sex,fever,congestive heart failure,left-ventricular ejection fraction4,fulminant myocarditis,abnormal creatine kinase-MB,and hypotension).Despite differences in the characteristics of the validation cohort,the model discrimination was only marginally lower,with an AUC of 0.781(95%confidence interval=0.675–0.852)compared with the derivation cohort.Model calibration likewise indicated acceptable fit(hosmer‒lemeshow goodness-of-fit,P¼=0.10).Conclusions Multiple factors were associated with increased mortality in children with AMC.The prediction model AMCDRS might be used at hospital admission to accurately identify AMC in children who are at an increased risk of death.

关键词： Acute myocarditis Bayesian model averaging Fulminant myocarditis hosmer–lemeshow test Mortality risk prediction model Pediatrics

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