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Clinical characteristics and risk factors of cardiac involvement in pediatric immunoglobulin A vasculitis: A 7-year retrospective study from a single tertiary medical center

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Abstract

Immunoglobulin A vasculitis(IgAV) is the most common form of systemic vasculitis affecting children. To date, cardiac involvement in pediatric IgAV has not been fully investigated and its prevalence may be underestimated. This study aims to reveal the clinical and laboratory characteristics of cardiac involvement in pediatric IgAV and further determine its risk factors. A total of 1451 children with IgAV were recruited between January 2016 and December 2022. According to the severity of cardiac involvement, the patients were divided into the myocarditis/suspected myocarditis group, cardiac abnormalities group, and non-cardiac involvement group. Demographic, clinical, and laboratory characteristics were retrospectively extracted from the individual data collected in the medical records. Among the 1451 pediatric IgAV patients, 179 (12.3%) were identified with cardiac involvement, including 154 (10.6%) with cardiac abnormalities and 25 (1.7%) with myocarditis/suspected myocarditis. Cardiac involvement in pediatric IgAV mainly manifested as elevated cardiac biomarker levels (n = 162), electrocardiogram abnormalities (n = 46), and echocardiogram/chest X-ray abnormalities (n = 15); however, cardiac-related symptoms were only observed in 15.1% of patients with cardiac involvement. Multivariate analysis demonstrated that interval from disease onset to diagnosis > 7 days (OR, 2.157; 95% CI, 1.523–3.057; p < 0.001), IgAV with multi-organ involvement (OR, 1.806; 95% CI, 1.242–2.627; p = 0.002), and elevated D-dimer levels (OR, 1.939; 95% CI, 1.259–2.985; p < 0.001) were independent risk factors for cardiac involvement in pediatric IgAV. The length of hospital stay was significantly longer in the myocarditis/suspected myocarditis group compared with the other two groups (p < 0.05).

    Conclusion: This study suggests that cardiac involvements in pediatric IgAV is non-negligible, and cardiac involvement is associated with interval from disease onset to diagnosis > 7 days, IgAV with multi-organ involvement, and elevated D-dimer levels. Severe cardiac involvement may affect the prognosis of pediatric IgAV.

What is Known:

• Immunoglobulin A vasculitis (IgAV) is the most common form of systemic vasculitis affecting children and adolescents, which exhibits diverse clinical manifestations. Cases of severe IgAV complicated by cardiac involvement have been anecdotally reported.

What is New:

• The present study suggests that cardiac involvements in pediatric IgAV is non-negligible, and cardiac involvement is associated with interval from disease onset to diagnosis > 7 days, IgAV with multi-organ involvement, and elevated D-dimer levels. Severe cardiac involvement may affect the prognosis of pediatric IgAV.

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Data availability

The data that support the findings of this study are available on request from the corresponding author, upon reasonable request.

Abbreviations

A-HBDH:

A-hydroxybutyric dehydrogenase

ASO:

Antistreptolysin O titer

AST :

Aspartate transferase

AVB :

Atrioventricular block

BASO :

Basophils

CI :

Confidence interval

CK-MB :

Creatine kinase-MB

CRP :

C-reactive protein

C3 :

Complement 3

C4 :

Complement 4

ECG :

Electrocardiogram

EO :

Eosinophils

ESR :

Erythrocyte sedimentation rate

EULAR :

European League against Rheumatism

LDH :

Lactate dehydrogenase

HSP :

Henoch-Schönlein purpura

IgAV :

Immunoglobulin A vasculitis

IQR:

Interquartile range

MR :

Mitral regurgitation

PLT :

Platelet counts

RBC :

Red blood cell counts

SD :

Standard deviation

TR :

Tricuspid regurgitation

WBC :

White blood cell counts

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Authors and Affiliations

  1. Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, People’s Republic of China

    Yue Cao, Xin Chen, Qi Peng, Tian Tuo Huang & Xiao Chen Fan

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  1. Yue Cao
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  2. Xin Chen
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  3. Qi Peng
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Contributions

All authors contributed to the study conception and design. YC, XC, and XCF were responsible for the conception of this study. YC, XC, and QP collected the data. YC and QP analyzed and interpreted the data. YC and TTH wrote the main manuscript text. XC and QP prepared figures. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Xiao Chen Fan.

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This study was performed in line with the principles of the Declaration of Helsinki. The study protocol was approved by the Ethics Committee of the First Affiliated Hospital of Anhui Medical University and individual consent for this retrospective analysis was waived.

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Communicated by Peter de Winter

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Cao, Y., Chen, X., Peng, Q. et al. Clinical characteristics and risk factors of cardiac involvement in pediatric immunoglobulin A vasculitis: A 7-year retrospective study from a single tertiary medical center. Eur J Pediatr 183, 1871–1880 (2024). https://doi.org/10.1007/s00431-024-05438-1

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