Determinants of possible inflammatory myocardial damage in acute intestinal infections in children

BACKGROUND: Non-coronary cardiomyopathies, including inflammatory cardiomyopathies, are one of the leading causes of disability and mortality in children and adults. Inflammatory cardiomyopathy in most cases is an outcome of myocarditis as a result of direct agent-dependent myocardial damage or autoimmune reactions in the absence of genetic predisposition.

AIM: On the basis of clinical assessment of cardiovascular system changes, to develop a discriminant model to predict the possibility of myocardial damage of inflammatory genesis in acute intestinal infections (AII) in children.

MATERIALS AND METHODS: In the Intestinal Infections Department of the Children’s Research and Clinical Center for Infectious Diseases of FMBA of Russia in the period 2020-2022, 33 children aged from 1 month to 13 years with AII of different etiology were consecutively observed, in whom, according to clinical, laboratory and instrumental examination data, for the first time in their lives, changes in cardiovascular system were detected. The sample was formed using an algorithm for diagnosing inflammatory myocardial lesions in points, the sum of which concluded that there were no or presence of such, which allowed us to identify group 1 (n = 24) and group 2 (n = 9), respectively. Etiological diagnosis of acute intestinal infections was performed in all children, clinical and laboratory data, results of a 12-channel electrocardiogram (ECG), transthoracic echocardiography (EchoCG) were evaluated. The differences in the groups were revealed using the Pearson chi-squared test and the Mann–Whitney test, which were considered reliable at p < 0.05. The method of discriminant analysis was used.

RESULTS: Functional systolic noise and increased cardiospecific enzymes were observed less frequently in group 1 than in group 2 (4.2%; 22.2% and 67%; 100%). Of the pathological ECG changes, violations of the repolarization process were observed (16.7%; 33.3%). No significant changes in the Echo-KG were detected. The viral etiology of acute intestinal infections dominated (79.2%; 88.9%). Changes in the hemogram were characterized by a high frequency of leukocytosis in group 1 (29.2%; 0%) and leukopenia in group 2 (4.2%; 22.2%). In group 1, there was a higher frequency of neutrophilosis (79.2%; 44.4%), rod-shaped shift (62.5%; 22.2%), thrombocytosis (29.2%; 0%), lymphocytopenia (95.8%; 55.6%; p < 0.05), monocytosis (8.3%; 0%); increased C-reactive protein (41.7%; 33.3%), ALT (29.2%; 11.1%), urea (29.2%; 11.1%), leukocyturia (16.7%; 0%).

CONCLUSIONS: Clinical evaluation of cardiovascular system changes in children with acute intestinal infections using a discriminant model allows to exclude myocardial damage of inflammatory genesis with high probability (95.7%), which is of practical importance.