The Influence of Diagnoses of Specific Viral Infections on In-Hospital Mortality, Length of Stay and Cost in Patients Admitted to Hospital with a Diagnosis of Myocarditis: An Analysis of the National Inpatient Sample

Chun Shing Kwok^1,2, Maximilian Will³, Deddo Moertl³, Adnan I. Qureshi⁴, Josip A. Borovac^5,*

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¹ Department of Post Qualifying Healthcare Practice, Birmingham City University, B15 3TN Birmingham, UK

² Department of Cardiology, University Hospitals of North Midlands NHS Trust, ST4 6QG Stoke-on-Trent, UK

³ Department of Internal Medicine 3, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, 3500 Krems, Austria

⁴ Department of Neurology, Zeenat Qureshi Stroke Institute, University of Missouri, Columbia, MO 65212, USA

⁵ Division of Interventional Cardiology, Cardiovascular Diseases Department, University Hospital of Split, 21000 Split, Croatia

^*Correspondence: josip.borovac@me.com; jborovac@mefst.hr (Josip A. Borovac)

Rev. Cardiovasc. Med. 2023, 24(7), 206; https://doi.org/10.31083/j.rcm2407206

Submitted: 18 April 2023 | Revised: 7 June 2023 | Accepted: 13 June 2023 | Published: 17 July 2023

(This article belongs to the Special Issue Congestive Heart Failure)

This is an open access article under the CC BY 4.0 license.

Abstract

Background: The influence of different viral infections in patients with myocarditis is unknown. Myocarditis is an inflammatory disease of heart muscle that is commonly caused by viruses. The impact of different viral infections in patients with myocarditis is unknown. Methods: We conducted a retrospective cohort study using data between 2016–2020 in the National Inpatient Sample in the USA to evaluate admissions with myocarditis and concomitant viral infection. The outcomes of in-hospital mortality, length of stay (LoS), and cost, among patients hospitalized for myocarditis was evaluated. Results: A total of 27,050 hospital admissions for myocarditis were included and 6750 (25.0%) had a co-diagnosis of viral infection. Patients with myocarditis and viral infection had significantly higher mortality compared to those without viral infection (23.6% vs. 4.4%, p $<$ 0.001). Viral infection was associated with increased in-hospital mortality (odds ratio (OR) 2.03, 95% CI 1.51 to 2.73, p $<$ 0.001), greater median LoS (7 vs. 3 days, p $<$ 0.001) and median hospitalization cost ($21,445 vs. $11,596, p $<$ 0.001), compared to patients without viral infection. The rate of death was greatest for patients with a diagnosis of coronavirus disease 2019 (COVID-19), viral pneumonia and herpes zoster, respiratory syncytial virus, chronic hepatitis, and influenza which was 36.0%, 34.3%, 27.3%, 21.4%, 20.0%, and 14.5%, respectively. Conclusions: In conclusion, the diagnosis of viral infection is present in one in four patients hospitalized with myocarditis and is correlated with greater mortality, LoS, and in-hospital cost.