Single-case metanalysis of fat embolism syndrome
Single-case metanalysis of fat embolism syndrome
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脂肪栓塞综合征的单例荟萃分析
DOI：
10.1016/j.ijcard.2021.10.151
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发表时间：
2021-11-17
影响因子：
3.5
通讯作者：
Wang, Dao Wen
中科院分区：
文献类型：
--
作者：
He, Zuowen;Shi, Zeqi;Wang, Dao Wen
背景：目前仅有一个关于脂肪栓塞综合征（FES）的大型系列报道，这是一种主要由骨折引起的脂肪球释放到循环系统中引起的疾病。因此，需要更多关于临床特征、治疗和预后的资料。方法与结果：本研究筛选了2010年6月至2020年6月在PubMed和Web of Science上发表的1090篇FES病例论文。作者确定了124项研究，并纳入了135例患者（14岁），外加1例同济医院管理的未发表病例。所有患者均确诊为FES，临床资料完整。就诊时的中位年龄为39岁，男性82例（61.8%）。FES主要与骨折相关（78,57.4%），尤其是股骨骨折（59,43.4%）。发病时最常见的临床表现是呼吸异常，占所有临床表现的34.6%。治疗包括呼吸支持治疗127例（93.4%），应用皮质类固醇22例（16.2%），抗凝剂5例（3.7%）。总体死亡率为30.2% (N = 41)， logistic回归分析显示皮质类固醇治疗与死亡率降低显著相关，OR为0.143 (95%CI 0.029-0.711)，而年龄>= 65岁和非骨科疾病与死亡率升高显著相关，OR为4.816 （95%CI 1.638-14.160）和4.785 （95%CI 1.019-22.474）。结论：FES与先前观察到的更高的死亡率相关，尽管发表偏倚可能导致对死亡率的高估。最后，目前的分析表明，皮质类固醇治疗具有潜在的保护作用。
Background: Only one large series has been reported on fat embolism syndrome (FES), a condition caused by fat globules release into the circulation, primarily as consequence of bone fracture. Thus, more data on clinical features, therapies, and prognosis are needed.Methods and results: The study screened 1090 manuscripts in PubMed and Web of Science on cases of FES published from June 2010 to June 2020. The authors identified 124 studies and included in the pooled-analysis 135 patients (>14 years), plus one additional unpublished case managed in Tongji hospital. All had confirmed diagnosis of FES with complete clinical data. The median age at presentation was 39 years, and 82 (61.8%) were men. FES was predominantly associated with bone fractures (78, 57.4%), particularly femur fracture (59, 43.4%). The most common clinical finding at the onset was respiratory abnormalities in 34.6% of all clinical presentations. Therapies included respiratory supportive care in 127 (93.4%) patients, application of corticosteroids in 22 (16.2%) and anticoagulant in 5 (3.7%) cases. Overall mortality was 30.2% (N = 41), and logistic regression analysis showed that corticosteroid therapy was significantly associated with reduced mortality with an OR of 0.143 (95%CI 0.029-0.711), while age >= 65 years and non-orthopedic conditions were significantly associated with increased mortality with an OR of 4.816 (95%CI 1.638-14.160) and 4.785 (95%CI 1.019-22.474).Conclusions: FES has been associated with a larger mortality rate than previously observed, although publication bias can have led to overestimation of mortality. Finally, a potential protective effect of corticosteroid therapy has been suggested by the current analysis.