The value of serum CARD9 and NLRX1 in the diagnosis and prognosis evaluation of viral myocarditis in children

Wang Xuehong; Chen Dan; Bai Dongqin; Zhang Yanfeng; Wu Xiaoyu

doi:10.3969/j.issn.1671-6450.2025.06.012

Abstract：Objective To investigate the value of serum caspase recruitment domain family member 9(CARD9)and nucleotide-binding oligomerization domain-like receptor family member X1(NLRX1)in the diagnosis and prognosis e-valuation of viral myocarditis(VMC)in children.Methods A total of 110 children with VMC admitted to the Department of Pediatrics of Yan'an People's Hospital from January 2021 to September 2023 were selected as VMC group and 110 healthy children in the same period were selected as healthy control group.VMC children were divided into poor prognosis subgroup(32 cases)and good prognosis subgroup(78 cases)according to 1-year prognosis.The levels of serum CARD9 and NLRX1 were detected by enzyme-linked immunosorbent assay.Multivariate unconditional Logistic regression analysis was used to an-alyze the relationship between serum CARD9,NLRX1 levels and poor prognosis of VMC in children.ROC curve was used to analyze the diagnostic value and prognostic value of serum CARD9 and NLRX1 levels in children with VMC.Results Compared with the healthy control group,the level of serum CARD9 of the VMC group increased and the level of NLRX1 decreased(t/P=10.679/＜0.001,10.203/＜0.001);After 1 year of follow-up,the poor prognosis rate of 110 children with VMC was 29.09％(32/110);compared with the good prognosis subgroup,the level of serum CARD9 increased and the level of NLRX1 decreased in the poor prognosis subgroup(t/P=5.863/＜0.001,5.808/＜0.001);High-sensitivity C-reactive protein,high creatine kinase isoenzyme MB,high cardiac troponin Ⅰ and high CARD9 were independent risk factors for poor prognosis of children with VMC,and high NLRX1 was an independent protective factor[OR(95％CI)=3.372(1.421-8.005),1.178(1.002-1.386),3.104(1.420-6.789),1.081(1.030-1.133),0.613(0.397-0.946)];the AUC of serum CARD9,NLRX1 and the two in the diagnosis of VMC in children were 0.848,0.840 and 0.919,respectively.The combination of the two was superior to their re-spective predictive values(Z/P=3.855/＜0.001,3.884/＜0.001);the AUC of serum CARD9,NLRX1 and the two in evaluating the poor prognosis of children with VMC were 0.805,0.787 and 0.894,respectively.The combination of the two was superior to the value of each alone in evaluating the poor prognosis of children with VMC(Z/P=2.611/0.009,2.737/0.006).Conclusion The increase of serum CARD9 level and the decrease of serum NLRX1 level of children with VMC are closely related to the decrease of prognosis,the combination of serum CARD9 and NLRX1 levels has high value in the diagnosis and prognosis evaluation of children with VMC.