Clinical Predictors and Long-Term Outcomes in Patients with Acute Pericarditis: A Prospective Observational Study

Abstract

Abstract

Acute pericarditis may follow a self-limiting course, yet recurrence, persistent inflammation, rehospitalization, tamponade, and constrictive complications remain clinically important. This prospective observational cohort study evaluated clinical predictors and long-term outcomes in adults with acute pericarditis. Consecutive patients were enrolled between January 2023 and December 2024 and followed for up to 24 months. Baseline demographic, clinical, laboratory, electrocardiographic, echocardiographic, etiological, and treatment variables were recorded. Cox proportional hazards regression and Kaplan–Meier analysis were used to identify predictors of composite adverse outcomes and estimate recurrence-free survival. Among 240 patients, the mean age was 42.7±15.6 years, 61.7% were male, and 65.4% had idiopathic or presumed viral disease. Clinical improvement within seven days occurred in 82.1%, while C-reactive protein normalized within four weeks in 80.9% of tested patients. Recurrent pericarditis occurred in 20.0%, while 27.1% experienced a composite adverse outcome. Initial treatment failure was the strongest independent predictor of adverse outcomes (adjusted hazard ratio [aHR], 3.84; 95% confidence interval [CI], 2.18–6.77), followed by moderate or large pericardial effusion (aHR, 2.11), previous pericarditis (aHR, 1.96), and subacute presentation (aHR, 1.89). Colchicine therapy was independently protective (aHR, 0.52). These findings support early risk stratification using treatment response, effusion size, recurrence history, and presentation pattern, with intensified follow-up for high-risk patients and reduced preventable long-term clinical complications.