Cardiac injury in children with severe hand, foot and mouth disease: risk factors and clinical outcomes

Purpose To determine the risk factors and clinical outcomes of cardiac injury in pediatric patients with severe hand, foot, and mouth disease (HFMD). Methods We conducted a multicenter retrospective study at two tertiary children’s hospitals in southern Vietnam, including hospitalized patients with severe HFMD and suspected cardiovascular complications. Cardiac injury was identified according to cardiac enzyme results and findings from electrocardiography and echocardiography. Univariable and multivariable logistic regression analyses were used to identify risk factors associated with cardiac injury. Results A total of 395 patients were included, with a male predominance, and 96.5% were younger than 36 months. Typical skin rash and herpangina remained the most common clinical manifestations. Intensive care unit admission was required in 72.2% of cases, and 50.9% required endotracheal intubation with mechanical ventilation. Cardiac injury was identified in 7.3% (29/395) of severe HFMD cases with suspected cardiovascular complications. Fever ≥ 39 °C (aOR 10.5, 95% CI 3.4–32.6, p < 0.001), C-reactive protein > 20 mg/L (aOR 3.3, 95% CI 1.3–8.4, p = 0.012), and aspartate aminotransferase > 40 U/L (aOR 4.1, 95% CI 1.7–9.8, p = 0.002) were independent risk factors for cardiac injury. Patients with cardiac injury had higher mortality, longer hospital stays, and a greater incidence of neurological sequelae compared with those without cardiac injury. Conclusions Cardiac injury in pediatric patients with severe HFMD is associated with adverse clinical outcomes, underscoring the need for early risk stratification and comprehensive cardiac assessment.