Zhuang et al reported a model for predicting mortality for a pediatric patient with acute myocarditis. This can identify a patient who may require more aggressive management. The authors are from Children's Hospital of Fudan University in Shanghai.
Patient selection: age <= 18 years, acute myocarditis (symptoms < 10 days)
Parameters:
(1) sex
(2) temperature in °C
(3) congestive heart failure
(4) left ventricular ejection fraction (LVEF) in percent
(5) pulmonary edema
(6) ventricular tachycardia
(7) serum lactic acid in mmol/L
(8) fulminant myocarditis
(9) abnormal serum CK-MB (since serum CK-MB is being performed less often, troponin may be a more relevant biomarker)
(10) hypotension
|
Parameter
|
Finding
|
Points
|
|
sex
|
male
|
1
|
|
|
female
|
0
|
|
temperature
|
<= 38.5°C
|
0
|
|
|
> 38.5°C (fever)
|
2
|
|
congestive heart failure
|
no
|
0
|
|
|
yes
|
9
|
|
LVEF
|
>= 50%
|
0
|
|
|
< 50%
|
11
|
|
pulmonary edema
|
no
|
0
|
|
|
yes
|
3
|
|
ventricular tachycardia
|
no
|
0
|
|
|
yes
|
4
|
|
serum lactic acid
|
<= 4 mmol/L
|
0
|
|
|
> 4 mmol/L
|
4
|
|
fulminant myocarditis
|
no
|
0
|
|
|
yes
|
18
|
|
serum biomarker
|
normal
|
0
|
|
|
abnormal
|
2
|
|
hypotension
|
no
|
0
|
|
|
yes
|
5
|
where:
• Congestive heart failure, reduced LVEF and pulmonary edema interact.
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 59
|
Total Score
|
Risk of Mortality
|
|
0 to 14
|
< 6%
|
|
15
|
(0.05053 * ((score)^2)) - (1.675 * (score)) + 19.99
|
risk of mortality =
= (0.05053 * ((score)^2)) - (1.675 * (score)) + 19.99
Performance:
• The area under the ROC curve is 0.83.
