# Short-term outcome and prognostic factors in acute fulminant myocarditis with acute kidney injury patients

## TL;DR

This study examines factors affecting short-term survival in patients with acute fulminant myocarditis and acute kidney injury, identifying urine volume and heart function as key predictors.

## Contribution

The study identifies 24-hour urine volume and ejection fraction as independent prognostic markers for 30-day mortality in acute fulminant myocarditis with acute kidney injury.

## Key findings

- Higher SIRI, leukocyte counts, and NLR correlated with increased 30-day mortality in AFM with AKI.
- Reduced 24-hour urine volume and lower ejection fraction were independently associated with higher mortality.
- The death group required more intensive treatments like ECMO and renal replacement therapy compared to survivors.

## Abstract

To evaluate the impact of the systemic inflammatory response index (SIRI) and other clinical features on short-term outcome in patients with acute fulminant myocarditis (AFM) complicated by acute kidney injury (AKI).

We retrospectively analyzed patients diagnosed with AFM and AKI at Fuwai Central China Cardiovascular Hospital between March 2018 and September 2024. Patients were divided into survival and death groups according to 30-day mortality. Demographic data, vital signs, laboratory parameters, echocardiographic findings, and treatment details were compared between the two groups. Multivariate logistic regression analysis was performed to examine independent predictors of 30-day mortality, and receiver operating characteristic (ROC) curve analysis was performed to assess their predictive value.

A total of 118 patients were included (median age: 41 years; 52.5% male). The death group (n = 44) had higher rates of respiratory failure and use of extracorporeal membrane oxygenation, mechanical ventilation and continuous renal replacement therapy than the survival group (n = 74). Proteinuria, leukocyte and neutrophil counts, neutrophil-lymphocyte ratio (NLR), SIRI, troponin, creatine kinase, lactate dehydrogenase, aspartate aminotransferase, and serum creatinine were significantly higher in the death group, while 24-h urine volume, ejection fraction (EF), blood pressure, and hospitalization time were lower (all p < 0.05). Leukocyte count, neutrophil count, NLR, and SIRI correlated positively with 30-day mortality. Multivariate analysis identified 24-h urine volume (OR 0.999, 95%CI 0.999–1.000, p = 0.036) and EF (OR 0.944, 95%CI 0.896–0.995, p = 0.032) as independent predictors. ROC curve analysis showed good predictive value (AUC 0.819 for urine volume and 0.740 for EF).

SIRI was associated with 30-day mortality in AFM and AKI, while only reduced 24-h urine volume and EF were independent prognostic markers.