Clinically suspected pediatric myocarditis in a resource-limited setting: high mortality, care gaps, and real-world management over a 12-year period

Q: What are the key findings of this study?

In a resource-limited setting, clinically suspected pediatric myocarditis had a 40.0% in-hospital mortality rate, with persistent liver dysfunction independently increasing the odds of death by over six-fold (aOR 6.35).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Clinically suspected pediatric myocarditis (n=130). Intervention: Persistent liver dysfunction vs. Absence of persistent liver dysfunction. Primary outcome: In-hospital mortality (aOR 6.35, 95% CI 2.40-18.25, p=<0.001).

Q: What does this research mean for the field?

In children with clinically suspected myocarditis, persistent liver dysfunction is strongly associated with increased in-hospital mortality. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To assess the clinical presentation, real-world management, in-hospital mortality, and multivariable predictors of death among pediatric patients with clinically suspected myocarditis in a resource-limited setting.

Fatima Ali; Muhammad Zabih Ullah; Tahir Munir; Asra Usmani; Nazia Samad; Saleem Akhtar; Babar Hasan

doi:10.1186/s12887-026-07413-1

August 31, 2026BMC PediatricsOpen Access

Clinically suspected pediatric myocarditis in a resource-limited setting: high mortality, care gaps, and real-world management over a 12-year period

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Key result

Persistent liver dysfunction is linked to ~6-fold higher mortality in pediatric myocarditis.

aOR 6.35
95% CI 2.40-18.25
P<0.001
n=130

Why the study?

Data on clinically suspected pediatric myocarditis from low- and middle-income countries are limited because advanced diagnostic tools are often unavailable.

Key Points

To assess the clinical presentation, real-world management, in-hospital mortality, and multivariable predictors of death among pediatric patients with clinically suspected myocarditis in a resource-limited setting.
Retrospective observational cohort study of 130 children aged 1 month to 18 years admitted to a tertiary care hospital in Pakistan between January 2011 and June 2023.
Inclusion required clinically suspected myocarditis based on compatible clinical signs, elevated cardiac biomarkers (troponin I, NT-proBNP), and echocardiographic evidence of myocardial dysfunction.
Multivariable logistic regression was performed to determine independent predictors of in-hospital mortality.
In-hospital mortality was 40.0% (52/130), with severe left ventricular systolic dysfunction (ejection fraction <30%) present in 77.7% and 75.4% requiring mechanical ventilation.
Independent predictors of in-hospital mortality were persistent liver dysfunction (aOR 6.35, 95% CI 2.40–18.25), arrhythmias requiring treatment (aOR 3.84, 95% CI 1.23–13.16), and ejection fraction <30% (aOR 3.28, 95% CI 1.16–10.19).
No patient underwent cardiac MRI or endomyocardial biopsy; among survivors, 33.3% were lost to follow-up and 46.2% of those assessed had persistent ventricular dysfunction.

Study Design

Type

Cohort (n=130)

Multicenter

No

Structured PICO

P

Population

130 children aged 1 month to 18 years with clinically suspected myocarditis admitted to a tertiary care hospital in Pakistan, evaluated for in-hospital mortality and predictors of death.

O

Outcome

In-hospital mortalityhard clinical

Main Result

Odds Ratio: 6.35 (95% CI 2.4–18.25)

p-value: p=<0.001

In a resource-limited setting, clinically suspected pediatric myocarditis is associated with a high in-hospital mortality of 40%, with severe LV dysfunction, persistent liver dysfunction, and arrhythmias serving as strong independent predictors of death.

Limitations

Retrospective, single-center study which may have preferentially captured the sickest children, limiting generalizability
Diagnosis based on clinical, biochemical, and echocardiographic criteria because CMR and biopsy were unavailable, raising the possibility of misclassification
Treatment was not standardized, precluding assessment of therapeutic efficacy
Detailed information on cardiopulmonary resuscitation, specific vasoactive medication exposure, and formal cardiogenic shock staging was not consistently documented
Follow-up data were incomplete, limiting interpretation of long-term outcomes
Retrospective, single-center study which may have preferentially captured the sickest children
Diagnosis based on clinical, biochemical, and echocardiographic criteria because CMR and biopsy were unavailable
Treatment was not standardized
Modest sample size

Implication

Persistent liver dysfunction signals high mortality risk in suspected pediatric myocarditis; hypothesis-generating for prospective validation and care strategies in resource-limited settings.

Abstract

Background Data on clinically suspected pediatric myocarditis from low- and middle-income countries are limited because advanced diagnostic tools are often unavailable. We evaluated the clinical presentation, management, outcomes, predictors of in-hospital mortality, and system-level care gaps in children with clinically suspected myocarditis in a resource-limited setting. Methods We conducted a retrospective observational cohort study at a tertiary care hospital in Pakistan. Children aged 1 month to 18 years admitted between January 2011 and June 2023 with clinically suspected myocarditis based on compatible clinical presentation, elevated cardiac biomarkers, and echocardiographic evidence of myocardial dysfunction were included. The primary outcome was in-hospital mortality. Multivariable logistic regression was used to identify independent predictors of death. Results A total of 130 children were included (mean age 3.7±4.5 years; 57.7% male). Severe left ventricular systolic dysfunction (ejection fraction <30%) was present in 77.7%, and 75.4% required mechanical ventilation. In-hospital mortality was 40.0% (52/130). Persistent liver dysfunction (aOR 6.35, 95% CI 2.40 – 18.25), arrhythmias requiring treatment (aOR 3.84, 95% CI 1.23 - 13.16), and ejection fraction <30% (aOR 3.28, 95%CI 1.16 - 10.19) were independently associated with mortality. Among survivors, one-third were lost to follow-up, and 46.2% of those with follow-up had persistent ventricular dysfunction. No patient underwent cardiac magnetic resonance imaging or endomyocardial biopsy because these modalities were unavailable. Conclusions Clinically suspected pediatric myocarditis was associated with high mortality, severe ventricular dysfunction, and incomplete recovery. Simple clinical markers may aid risk stratification, while strengthening early recognition and follow-up may improve outcomes in low-resource settings.

Discussion

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Cite This Study

Ali et al. (2026) conducted a cohort in Clinically suspected pediatric myocarditis (n=130). Persistent liver dysfunction vs. Absence of persistent liver dysfunction was evaluated on In-hospital mortality (aOR 6.35, 95% CI 2.40-18.25, p=<0.001). In a resource-limited setting, clinically suspected pediatric myocarditis had a 40.0% in-hospital mortality rate, with persistent liver dysfunction independently increasing the odds of death by over six-fold (aOR 6.35).

synapsesocial.com/papers/6a969c41535111e2d4ce8d1f https://doi.org/10.1186/s12887-026-07413-1

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Clinically suspected pediatric myocarditis in a resource-limited setting: high mortality, care gaps, and real-world management over a 12-year period

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Clinically suspected pediatric myocarditis in a resource-limited setting: high mortality, care gaps, and real-world management over a 12-year period

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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