What does this research mean for the field?

Elevated LDH levels (OR 1.001) and T-wave changes (OR 3.509) are independent risk factors for short-term adverse outcomes in pediatric fulminant myocarditis. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

The study aims to identify risk factors for adverse outcomes in pediatric fulminant myocarditis and develop predictive models for early identification.

February 8, 2026

Analysis of risk factors and construction of predictive model for adverse outcomes of fulminant myocarditis in children

Key Result

Elevated LDH (OR 1.001) and T-wave changes (OR 3.509) predict short-term adverse outcomes with AUC 0.827; higher ALB and lower LVEF predict long-term outcomes similarly.

Key Points

The study aims to identify risk factors for adverse outcomes in pediatric fulminant myocarditis and develop predictive models for early identification.
Included 121 children diagnosed with fulminant myocarditis.
Divided patients based on survival status and clinical findings.
Used univariate and LASSO regression analyses to identify risk factors.
Employed multivariate logistic regression to confirm independent risk factors.
Evaluated model performance using ROC and calibration curves.
Elevated lactate dehydrogenase and T-wave changes on ECG are linked to short-term adverse outcomes.
The predictive model for short-term outcomes had an AUC of 0.827 with good sensitivity and specificity.
Higher albumin levels and lower left ventricular ejection fraction correlated with long-term adverse outcomes.
The long-term model also showed an AUC of 0.827, indicating its predictive accuracy.

Structured PICO

Population

121 children diagnosed with fulminant myocarditis (FM)

Outcome

Short-term and long-term adverse outcomes (based on survival status, electrocardiogram, and echocardiogram findings)composite

Predictive models incorporating LDH, T-wave changes, albumin, and LVEF can accurately identify pediatric patients with fulminant myocarditis at high risk for short- and long-term adverse outcomes.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract Background Fulminant myocarditis (FM) is a severe form of acute myocarditis. This study aims to identify risk factors associated with adverse outcomes in pediatric FM and to develop a predictive model for early clinical identification of high-risk patients. Methods A total of 121 children diagnosed with FM were included. Based on survival status, electrocardiogram, and echocardiogram findings, patients were divided into two groups. Clinical data collected during hospitalization were analyzed using univariate and LASSO regression analyses to identify potential risk factors. Multivariate logistic regression was then employed to determine independent risk factors for short-term and long-term adverse outcomes, and a predictive model was constructed. The model's performance was evaluated using ROC curves, calibration curves, and decision curve analysis. Results Short-term adverse outcomes: Elevated lactate dehydrogenase (LDH) levels (OR 1.001, 95% CI 1.001–1.002, P 0.001) and T-wave changes on ECG (OR 3.509, 95% CI 1.300–9.471, P = 0.013) were identified as independent risk factors for short-term adverse outcomes. The predictive model, Predict1 = -3.058 + 0.001 (LDH) + 1.255 (T-wave change), demonstrated an AUC of 0.827, with an optimal cut-off value of 0.29 (sensitivity 73.7%, specificity 84.3%). The Hosmer-Lemeshow (H-L) test yielded χ2 = 5.800 (P = 0.670), and the DCA indicated strong clinical utility. Long-term adverse outcomes: Higher albumin (ALB) levels (OR 1.209, 95% CI 1.021–1.432, P = 0.028) and lower LVEF at discharge (OR 0.840, 95% CI 0.747–0.944, P = 0.004) were identified as independent risk factors for long-term adverse outcomes. The predictive model, Predict2 = 0.553 + 0.190 (ALB) - 0.175 (LVEF), demonstrated an AUC of 0.827, with an optimal cut-off value of 0.11 (sensitivity 84.6%, specificity 72.7%). The H-L test yielded χ2 = 5.800 (P = 0.670), and the DCA indicated strong clinical utility. Additionally, significant differences were observed in LVEF values during hospitalization, at discharge, and at follow-up (P 0.001). Conclusion Elevated LDH levels at admission and T-wave changes on ECG during hospitalization are independent risk factors for short-term adverse outcomes in pediatric FM. These indicators were used to construct a predictive model with strong predictive accuracy, providing a valuable tool for early identification of short-term adverse outcomes. Higher ALB levels at admission and lower LVEF at discharge are independent risk factors for long-term adverse outcomes in pediatric FM. These indicators were used to develop a predictive model with strong predictive accuracy, offering a valuable tool for early identification of long-term adverse outcomes. Following treatment, children with FM demonstrated significant recovery in cardiac function during hospitalization and after discharge.

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