Li Shan, Gao Feng, Hu Hai-Ou, Shi Jin, Zhang Jie
Department of Gastroenterology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Beijing Anzhen Hospital, Capital Medical University, No. 5A, Cardiosurgical Ward, Beijing, China.
Gastroenterol Res Pract. 2020 Sep 17;2020:4850287. doi: 10.1155/2020/4850287. eCollection 2020.
Aortoesophageal fistula (AEF) related to aortic aneurysm and dissection is an uncommon but life-threatening condition. We performed a systematic review of risk factors for mortality and factors associated with the prognosis of AEF.
A systematic search of the PubMed, Embase, and Cochrane Library databases was performed. Clinical characteristics, diagnostic methods, and treatments were assessed in terms of their ability to predict mortality.
The systematic review identified 184 eligible articles including 219 patients with AEF. Multivariable Cox regression revealed positive correlations of hemorrhagic shock (hazard ratio (HR): 1.824, 95% CI: 1.217-2.735, = 0.004), sepsis (HR: 1.714, 95% CI: 1.112-2.641, = 0.015), multiorgan failure (HR: 3.060, 95% CI: 1.470-6.368, = 0.003), and conservative treatment (HR: 5.257, 95% CI: 3.405-8.116, < 0.001) with mortality and a negative correlation between combination therapy (aortic graft replacement and esophagectomy) and mortality (HR: 0.319, 95% CI: 0.125-0.813, = 0.017). Kaplan-Meier survival analysis showed that the 1-year cumulative survival rate was 42.5 ± 3.8%. The overall fistula-related mortality rate was 47.0% (103/219). The most common causes of death were bleeding (54.9%) and infection (29.2%).
We found that hemorrhagic shock, sepsis, and multiorgan failure were risk factors for death in patients with AEF. Additionally, conservative treatment was associated with a higher rate of mortality, while combined aortic graft replacement and esophagectomy improved the prognosis.
与主动脉瘤和主动脉夹层相关的主动脉食管瘘（AEF）是一种罕见但危及生命的疾病。我们对AEF的死亡风险因素及与预后相关的因素进行了系统评价。
对PubMed、Embase和Cochrane图书馆数据库进行系统检索。从预测死亡的能力方面评估临床特征、诊断方法和治疗方法。
该系统评价共纳入184篇符合条件的文章，包括219例AEF患者。多变量Cox回归显示，失血性休克（风险比（HR）：1.824，95%置信区间：1.217 - 2.735，P = 0.004）、脓毒症（HR：1.714，95%置信区间：1.112 - 2.641，P = 0.015）、多器官功能衰竭（HR：3.060，95%置信区间：1.470 - 6.368，P = 0.003）以及保守治疗（HR：5.257，95%置信区间：3.405 - 8.116，P < 0.001）与死亡率呈正相关，而联合治疗（主动脉移植置换术和食管切除术）与死亡率呈负相关（HR：0.319，95%置信区间：0.125 - 0.813，P = 0.017）。Kaplan - Meier生存分析显示，1年累积生存率为42.5 ± 3.8%。总的瘘管相关死亡率为47.0%（103/219）。最常见的死亡原因是出血（54.9%）和感染（29.2%）。
我们发现失血性休克、脓毒症和多器官功能衰竭是AEF患者死亡的风险因素。此外，保守治疗与较高的死亡率相关，而联合主动脉移植置换术和食管切除术可改善预后。
