Prognosis

Most cases of pericarditis are self-limiting with symptom duration less than 2 weeks. Small
to moderate effusion can be managed by close outpatient observation and resolve spontaneously
within weeks. Hospitalization is needed when the symptom persists or there is development of
new sign and worsen. Indication of poor prognosis includes temperature greater than 380C,
subacute onset, immunocompromised status, antecedent trauma, anticoagulant use, myocardial
involvement, large effusion, or cardiac tamponade, and purulent pericarditis. If the patient with
one or more of these entities are at increased risk of serious complications.(1)
Recurrent pericarditis occurs in 15 to 30% of idiopathic cases. The treatment of recurrent
pericarditis is still supportive treatment. After an initial episode of acute pericarditis about 30% of
patients have a recurrence. There are some factors associated to the morbidities of pericarditis and
have been validated in multivariate analysis the predictors of severe illness is divided into major
and minor factor. Major factor includes fever > 100.40F (380C), subacute onset, evidence
suggestive of cardiac tamponade, large pericardial effusion ( an echo-free space greater than 20
mm), and ineffective NSAID therapy after seven days, while minor predictor of severe illness
includes immunosuppressed state, history of oral anticoagulant therapy, acute trauma, elevated
cardiac troponin level (suggestive of myopericarditis).(2)
Based on research of Massimo Imazio et al. in total of 453 patients aged 17 to 90 years
with acute pericarditis were prospectively evaluated from January 1996 to August 2004 found the
poor prognostic predictors in patient with pericarditis includes, female gender, fever >380C,
subacute course, immunocompromised, trauma, oral anticoagulant, rise of cardiac troponin, large
pericardial effusion, cardiac tamponade, ASA or NSAID failure at 1 week. Corticosteroid therapy
(generally prednisone at the dose of 1.0 to 1.5 mg/kg per day for 2 to 4 weeks and the gradually
tapered) was restricted as initial therapy to patient with aspirin or NSAID contraindication (oral
anticoagulant therapy, allergy, history of peptic ulcer or gastrointestinal bleeding).(3)
Another risk factor for poor prognosis is lack of response to a NSAID after at least 1 week
therapy, failure to respond to a NSAID may imply the possibility of a specific cause, which include
neoplastic origin of acute pericardial disease. In this research complication were detected after 31
months of follow up in 95 patients and recurrences in 83 patients (table 1). Patients that diagnosed
with a specific cause showed a higher rate of complication compared with patient diagnosed with
idiopathic or viral pericarditis. In multivariate analysis women, patient with large effusion or
tamponade, and aspirin or NSAID failure were at increased rate of complications in idiopathic or
viral pericarditis. (3)(4)(5)
Table 1. Baseline Frequencies of Poor Prognostic Predictors in Patient With or Without
Complication During Follow-Up. (3)

1. Seidenberg PH, Haynes J. Pericarditis : Diagnosis , Management , and Return to Play.

2006;5:74–9.
2. Snyder MJ, Family N, Residency M, Air N, Base F, Bepko NJ, et al. Acute Pericarditis:
Diagnosis and Management. 2014;89:553.
3. Imazio M, Cecchi E, Demichelis B, Ierna S, Demarie D, Ghisio A, et al. Indicators of Poor
Prognosis of Acute Pericarditis. 2007;115:2739–44.
4. Imazio M, Spodick DH, Brucato A, Trinchero R, Adler Y. Controversial issues in the
management of pericardial diseases. Circulation. 2010;121(7):916-928.
5. Imazio M, Trinchero R. Triage and management of acute pericarditis. Int J Cardiol.
2007;118(3):286-294.