Cardiac injury in children with severe hand, foot and mouth disease: risk factors and clinical outcomes.

purposeTo determine the risk factors and clinical outcomes of cardiac injury in pediatric patients with severe hand, foot, and mouth disease (HFMD).

methodsWe conducted a multicenter retrospective study at two tertiary children's hospitals in southern Vietnam, including hospitalized patients with severe HFMD and suspected cardiovascular complications. Cardiac injury was identified according to cardiac enzyme results and findings from electrocardiography and echocardiography. Univariable and multivariable logistic regression analyses were used to identify risk factors associated with cardiac injury.

resultsA total of 395 patients were included, with a male predominance, and 96.5% were younger than 36 months. Typical skin rash and herpangina remained the most common clinical manifestations. Intensive care unit admission was required in 72.2% of cases, and 50.9% required endotracheal intubation with mechanical ventilation. Cardiac injury was identified in 7.3% (29/395) of severe HFMD cases with suspected cardiovascular complications. Fever ≥ 39 °C (aOR 10.5, 95% CI 3.4-32.6, p < 0.001), C-reactive protein > 20 mg/L (aOR 3.3, 95% CI 1.3-8.4, p = 0.012), and aspartate aminotransferase > 40 U/L (aOR 4.1, 95% CI 1.7-9.8, p = 0.002) were independent risk factors for cardiac injury. Patients with cardiac injury had higher mortality, longer hospital stays, and a greater incidence of neurological sequelae compared with those without cardiac injury.

conclusionsCardiac injury in pediatric patients with severe HFMD is associated with adverse clinical outcomes, underscoring the need for early risk stratification and comprehensive cardiac assessment.