Clinical characteristics and emergency department-based warning indicators of fulminant myocarditis in children
4 affiliations
- 1Department of Emergency Medicine, Shenzhen Children’s Hospital, Shantou University Medical College, Shenzhen, China
- 2Department of Neonatology, Shenzhen Children’s Hospital, Shantou University Medical College, Shenzhen, China
- 3Pediatric Intensive Care Unit, Shenzhen Children’s Hospital, Shantou University Medical College, Shenzhen, China
- 4Department of Pediatric Cardiology, Shenzhen Children’s Hospital, Shantou University Medical College, Shenzhen, China
Abstract
Background: Fulminant myocarditis (FM) in children is associated with a high mortality rate, while its early clinical manifestations are often nonspecific. This study aimed to identify early warning indicators available at emergency department (ED) presentations to facilitate early recognition of children at high risk of FM. Methods: A retrospective analysis was conducted on 140 children with acute myocarditis admitted through the ED between 01/01/2015 and 31/12/2024. Patients were classified into acute non-fulminant myocarditis (ANFM) (n = 86) and FM (n = 54) groups. The least absolute shrinkage and selection operator (LASSO) regression was utilized to optimize variable selection, followed by multivariable logistic regression analysis to identify early warning indicators of FM. Results: Gastrointestinal symptoms were the most common clinical manifestation in children with FM (88.9%). Compared with the ANFM group, children with FM had lower serum sodium levels and higher lactate and myocardial injury marker levels (all P < 0.05). Multivariable logistic regression identified five early warning indicators of FM: gastrointestinal symptoms (OR = 11.468, 95% CI: 2.495–52.713), lactate (OR = 1.887, 95% CI: 1.155–3.082), cardiac troponin I (cTnI) (OR = 1.188, 95% CI: 1.055–1.337), third-degree atrioventricular block (OR = 32.211, 95% CI: 2.943–352.484), and serum sodium (OR = 0.785, 95% CI: 0.652–0.944). Conclusions: Elevated lactate and cTnI, decreased serum sodium, gastrointestinal symptoms, and third-degree atrioventricular block at ED presentation may help identify children at high risk of FM. Prospective multicenter studies are needed to validate these findings.
Related
- Stochastic analysis of an emergency department with two levels sharing the servers
- Do Machine Learning-Guided Proactive Full Capacity Protocols Mitigate Emergency Department Overcrowding? A Simulation-Based Evaluation
- Association between nirsevimab coverage and pediatric emergency department visits for bronchiolitis in 12 European countries: An interrupted time-series analysis
- On Recoding Ordered Treatments as Binary Indicators*
- The binomial distribution maximises entropy among sums of negatively related indicators with fixed mean and support
BibTeX
@article{huang2026clinical,
title = {{Clinical characteristics and emergency department-based warning indicators of fulminant myocarditis in children}},
author = {Lingzhu Huang and Jingbo Jiang and Ying Qi and Xiaoxin Deng and Weike Ma and Xiaozhou Chen and Ping Song},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0358335},
url = {https://doi.org/10.1371/journal.pone.0358335},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Clinical characteristics and emergency department-based warning indicators of fulminant myocarditis in children
AU - Lingzhu Huang
AU - Jingbo Jiang
AU - Ying Qi
AU - Xiaoxin Deng
AU - Weike Ma
AU - Xiaozhou Chen
AU - Ping Song
PY - 2026
DA - 2026/09/17
JO - PLOS One
DO - 10.1371/journal.pone.0358335
UR - https://doi.org/10.1371/journal.pone.0358335
AB - Background: Fulminant myocarditis (FM) in children is associated with a high mortality rate, while its early clinical manifestations are often nonspecific. This study aimed to identify early warning indicators available at emergency department (ED) presentations to facilitate early recognition of children at high risk of FM. Methods: A retrospective analysis was conducted on 140 children with acute myocarditis admitted through the ED between 01/01/2015 and 31/12/2024. Patients were classified into acute non-fulminant myocarditis (ANFM) (n = 86) and FM (n = 54) groups. The least absolute shrinkage and selection operator (LASSO) regression was utilized to optimize variable selection, followed by multivariable logistic regression analysis to identify early warning indicators of FM. Results: Gastrointestinal symptoms were the most common clinical manifestation in children with FM (88.9%). Compared with the ANFM group, children with FM had lower serum sodium levels and higher lactate and myocardial injury marker levels (all P < 0.05). Multivariable logistic regression identified five early warning indicators of FM: gastrointestinal symptoms (OR = 11.468, 95% CI: 2.495–52.713), lactate (OR = 1.887, 95% CI: 1.155–3.082), cardiac troponin I (cTnI) (OR = 1.188, 95% CI: 1.055–1.337), third-degree atrioventricular block (OR = 32.211, 95% CI: 2.943–352.484), and serum sodium (OR = 0.785, 95% CI: 0.652–0.944). Conclusions: Elevated lactate and cTnI, decreased serum sodium, gastrointestinal symptoms, and third-degree atrioventricular block at ED presentation may help identify children at high risk of FM. Prospective multicenter studies are needed to validate these findings.
SN - 1932-6203
ER -