Prevalence of myocarditis in critically-ill pediatric patients in Qena University Hospital

Document Type : Original research articles

Authors

1 Department of Pediatrics, Faculty of Medicine, South Valley University, Qena, Egypt.

2 Department of Clinical Pathology, Faculty of Medicine, South Valley University, Qena, Egypt.

Abstract

Background: Myocarditis is a potentially life-threatening inflammatory disease affecting the myocardium. There are many different etiologies, most of which are infectious. The spectrum of presentations can range between subclinical disease and congestive heart failure, arrhythmias, and sudden death. Endomyocardial biopsy and cardiac magnetic resonance are the cornerstone in diagnosing myocarditis. However, they are not widely used. Therefore, myocarditis can be diagnosed clinically based on clinical presentation, laboratory investigations, and echocardiography.
Objectives: The aim was to evaluate the prevalence of myocarditis in critically-ill patients.
Patients and methods: Creatine kinase-myocardial band (CK-MB) and troponin-I were conducted on 203 critically-ill patients admitted in PICU and NICU as a screening test for myocarditis. If one or both of them were high, echocardiography was done to prove myocarditis. If the patient was diagnosed clinically to have myocarditis, Chest x-ray, ECG, and covid IgG, and IgM were done.
Results: CK-MB and troponin-I were within the normal range in 151 patients. One or both cardiac biomarkers were elevated in 52 patients, therefore, echocardiography was done for all of them and myocarditis was diagnosed clinically in 15 cases. CK-MB sensitivity in predicting myocarditis was 60% and specificity was 73.4%. Troponin-I was more sensitive (86.67%) and more specific (77.01%).
Conclusion: The prevalence of myocarditis was 7.4% in critically-ill pediatric patients. A high index of suspicion is required in diagnosing myocarditis. Troponin-I can be used as a screening test for myocarditis and results can be confirmed with echocardiography.

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