ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Pediatric Cardiology
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1678220
This article is part of the Research TopicEmerging Technologies in Imaging for Pediatric Heart ConditionsView all 6 articles
Early clinical predictors of fulminant myocarditis in pediatric patients:a retrospective cohort study
Provisionally accepted
- 1Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
- 2Sunshine Union Hospital, Weifang, China
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Objective: Various clinical indicators can increase the likelihood of early identification of fulminant myocarditis, the identification of which is important for early treatment. Method: The medical records of all patients (n=269) who were diagnosed with acute myocarditis between January 2014 and December 2023 were retrospectively analyzed. Patients were divided into two groups: the nonfulminant myocarditis group (n=229) 2 and the fulminant myocarditis group (n=40). Baseline demographics, laboratory findings, electrocardiograms, echocardiograms, and treatment regimens were compared between the two groups via multifactorial analysis. A receiver operating characteristic (ROC) curve was used to explore the predictive value of related factors. Results: The median age of patients with fulminant myocarditis was significantly greater than that in the nonfulminant group (P=0.015). The presenting symptoms at admission varied and included fever and respiratory, digestive, and circulatory symptoms. Among them, fever and hypotension were more common in the fulminant myocarditis group (P<0.05), and vomiting was significantly more common in the nonfulminant myocarditis group (P=0.017). Logistic regression analysis revealed that N-terminal pro-B-type natriuretic peptide (NT-proBNP), lactate (Lac), alanine aminotransferase (ALT), cardiac troponin I (cTnI), chest distress, and hypotension were early risk factors for fulminant myocarditis. ROC curve analysis demonstrated that NT-proBNP, ALT, cTnI, and Lac can serve as predictors for the early diagnosis of fulminant myocarditis. The optimal predictive values for these markers are 2783.5 pg/ml for NT-pro BNP, 34.5 U/L for ALT, 0.2 µg/ml for cTnI, and 3.05 mmol/L for Lac. Conclusions: This study revealed that NT-proBNP, cTnI, ALT, and Lac can serve as predictive factors for the early identification of fulminant myocarditis. These findings emphasize the importance of early identification and timely diagnosis for improving the overall prognosis of patients.
Keywords: Acute myocarditis, Fulminant myocarditis, Children, Factors risk, Clinical indicators
Received: 02 Aug 2025; Accepted: 29 Sep 2025.
Copyright: © 2025 Yuan, Li, Li, Wu, Wu, Huang, Yin and Zhou. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Na Zhou, 2023761102@gzhmu.edu.cn
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