Plain language summary
Viral myocarditis (VMC) is a kind of infectious myocardial disease in which viral infection triggers myocardial interstitial inflammatory cell infiltration and adjacent myocardial cell necrosis, further leading to cardiac dysfunction and other systemic damage. The current main treatment of VMC includes antiviral, myocardial nutritional support, and immunomodulatory measures, but conventional treatment (CT) often fails to effectively control the disease, and thus, the recurrence rate is high. The aim of this study was to investigate the clinical utility of creatine phosphate sodium (CPS) and/or vitamin C in the treatment of VMC in children. This study is a systematic review and meta-analysis of 19 studies. A total of 1,957 VMC patients were included, with 968 patients in the control group and 989 patients in the observation group. Results show that compared with the control group who underwent CT therapy alone, the observation group receiving CT therapy together with CPS and/or vitamin C, had better performance in effective rate and better myocardial markers. Authors conclude that their findings may help to guide and standardize the treatment of VMC in children.
Abstract
Background: This study performed a meta-analysis to explore the clinical efficacy of creatine phosphate sodium (CPS) and/or vitamin C for viral myocarditis (VMC) in children, to provide guidance for its clinical treatment. Methods: A literature search was performed on PubMed, Web of Science, Embase, China National Knowledge Infrastructure, and Wanfang databases to obtain published clinical randomized controlled trials (RCTs) on CPS and/or vitamin C for VMC in children, with a time span from 2013 to 2022. Relevant data was extracted and meta-analysis was performed using the statistical software Stata 16.0. Results: A total of 723 studies were retrieved and 19 studies were finally included for meta-analysis, with a total of 1,957 patients. The meta-analysis results showed that the observation group (conventional treatment + CPS and/or vitamin C) was superior to the control group (conventional treatment alone) in treatment effective rate (OR = 3.60, 95% CI (2.55, 5.07), and P < 0.001). Additionally, the observation group had lower levels of cardiac troponin-I (SMD = - 2.63, 95% CI (- 3.51, - 1.76), and P < 0.001), creatine kinase isoenzyme (SMD = -2.78, 95% CI (- 3.53, - 2.03), and P < 0.001), lactate dehydrogenase (SMD = -1.95, 95% CI (- 2.49, - 1.42), and P < 0.001), aspartate aminotransferase (SMD = -0.87, 95% CI (- 1.84, 0.09), and P = 0.076), tumor necrosis factor-α (SMD = -3.90, 95% CI (- 4.47, - 3.06), and P < 0.001), and higher superoxide dismutase levels (SMD = 2.48, 95% CI (1.64, 3.33), and P < 0.001). Except aspartate aminotransferase, there were significant differences between the two groups in the other parameters. Conclusion: CPS and/or vitamin C treatment could greatly improve the treatment, protect myocardial function, and relieve inflammatory response in children with VMC.
Methodological quality
Jadad score
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Allocation concealment
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