What is the clinical evidence from this study?

Study design: Observational. Population: Acute myocarditis (n=90). Intervention: Adrenaline administration vs. No adrenaline administration. Primary outcome: Mortality (OR 8.43, 95% CI 1.40-50.92, p=0.020).

What does this research mean for the field?

Adrenaline administration and the presence of a chronic underlying disease are independently associated with increased pediatric intensive care unit mortality in children with acute myocarditis. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

The aim is to identify mortality factors and hospital stay duration in children diagnosed with acute myocarditis.

May 20, 2026Cardiology in the Young0 citationsOpen Access

Evaluation of cases hospitalised in paediatric intensive care and the factors affecting mortality due to acute myocarditis

ÜBÜlkem Koçoğlu BarlasIstanbul Medeniyet University NANihal AkçaySağlık Bilimleri Üniversitesi MMMehmet Emin MenentoğluBakırköy Dr.Sadi Konuk Eğitim ve Araştırma Hastanesi

Key Result

Adrenaline administration (OR 8.43) and the presence of a chronic underlying disease (OR 6.65) were independently associated with increased PICU mortality in children with acute myocarditis.

Key Points

The aim is to identify mortality factors and hospital stay duration in children diagnosed with acute myocarditis.
Multicentre retrospective study across 11 pediatric intensive care units (PICUs) over 18 months.
Patients classified as survivors or non-survivors for comparison.
Length of stay (LOS) analyzed among survivors.
Among 90 patients, the PICU mortality rate was 21.1%.
Significant differences were found in sex distribution, chronic disease, hypoxia, and initial left ventricular ejection fraction (LVEF) (p < 0.05).
Younger age and lower initial LVEF were linked to longer PICU LOS for survivors.

Study Design

Type

Observational (n=90)

Multicenter

Yes

Structured PICO

Population

90 children diagnosed with acute myocarditis admitted to paediatric intensive care units (PICUs), 60% female.

Outcome

Mortality and duration of hospital and paediatric intensive care unit (PICU) stayhard clinical

In pediatric patients with acute myocarditis, younger age, lower initial LVEF, and higher intensive care scores and cardiac biomarkers are associated with prolonged PICU stay and mortality.

Main Result

Effect estimate: OR 8.43 (95% CI 1.40-50.92)

p-value: p=0.020

Limitations

Retrospective design introduces inherent biases
Diagnosis was based primarily on clinical and laboratory criteria rather than routine confirmation by endomyocardial biopsy or cardiac MRI
Inadvertent inclusion of primary cardiomyopathy and genetic aetiologies cannot be completely ruled out
NT-proBNP values were capped at the laboratory upper reporting limit, potentially limiting assessment of extreme elevations
Centre-level differences in clinical practice patterns and resource availability were not adjusted for
Higher IVIG utilisation rate among survivors may reflect a timing bias rather than a true treatment effect

Abstract

Abstract Objectives: This study aimed to identify the factors associated with mortality and the duration of hospital and paediatric intensive care unit (PICU) stay in children diagnosed with acute myocarditis (AM). Methods: This multicentre retrospective study was conducted across 11 PICUs over an 18-month period. Cases were classified as survivors or non-survivors, and comparisons were made between the two groups. The factors influencing hospital and PICU length of stay (LOS) were analysed only among survivors. Results: A total of 90 patients were included, of whom 54 (60%) were female. The PICU mortality rate was 21.1%. Significant differences between survivors and non-survivors were observed in sex distribution, presence of chronic disease, presenting symptoms (exercise intolerance and vomiting), hypoxia, hypotension, and tachycardia at admission, hospital LOS, intensive care scores, initial and peak pro-brain natriuretic peptide levels, initial and final left ventricular ejection fraction (LVEF), presence of cardiogenic shock, need for respiratory support, and use of inotropic agents (p < 0.05). Among survivors, younger age and lower initial LVEF were associated with longer PICU LOS, whereas higher intensive care scores and elevated cardiac biomarker levels showed positive correlations with both hospital and PICU LOS. Conclusion: In paediatric patients with AM, younger age, lower initial LVEF, and higher intensive care scores and cardiac biomarker values are associated with prolonged PICU stay. Early identification of these factors may help predict clinical course and optimise intensive care management.

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