Department of Post Qualifying Healthcare Practice, Birmingham City University, Birmingham, UK.
Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK.
J Thromb Thrombolysis. 2023 Aug;56(2):342-350. doi: 10.1007/s11239-023-02824-8. Epub 2023 Jun 5.
The factors associated with cerebral infarction and mortality in patients hospitalized with intracardiac thrombus are unknown. A retrospective cohort study was undertaken of nationally representative hospital admissions in the National Inpatient Sample with a diagnosis of intracardiac thrombus between 2016 to 2019. Multiple logistic regressions were used to define factors associated with cerebral infarction and in-hospital mortality. There were a total of 175,370 admissions for patients with intracardiac thrombus and 10.1% patients had cerebral infarction (n = 17,675). Intracardiac thrombus represented 4.4% of primary diagnosis for admissions while circulatory conditions (65.4%), infection (5.9%), gastrointestinal conditions (4.4%), respiratory conditions (4.4%) and cancer (2.2%) were the other prevalent primary diagnoses. All-cause mortality was higher for patients with cerebral infarction (8.5% vs 4.8%). The five factors most associated with cerebral infarction were nephrotic syndrome (OR 2.67 95%CI 1.05-6.78), other thrombophilia (OR 2.12 95%CI 1.52-2.95), primary thrombophilia (OR 1.99 95%CI 1.52-2.53), previous stroke (OR 1.61 95%CI 1.47-1.75) and hypertension (OR 1.41 95%CI 1.27-1.56). The strongest independent predictors of death were heparin induced thrombocytopenia (OR 2.45 95%CI 150-4.00), acute venous thromboembolism (OR 2.03 95%CI 1.78-2.33, p < 0.001) acute myocardial infarction (OR 1.95 95%CI 1.72-2.22), arterial thrombosis (OR 1.75 95%CI 1.39-2.20) and cancer (OR 1.57 95%CI 1.36-1.81). Patients with intracardiac thrombus are at risk of cerebral infarction and in-hospital mortality. Nephrotic syndrome, thrombophilia, previous stroke, hypertension, and heparin induced thrombocytopenia were associated with cerebral infarction, while acute venous thromboembolism, acute myocardial infarction, and cancer were predictors of mortality.
患有心内血栓的住院患者发生脑梗死和死亡的相关因素尚不清楚。本研究采用回顾性队列研究，纳入了 2016 年至 2019 年全国住院患者样本数据库中诊断为心内血栓的患者。采用多因素逻辑回归分析确定与脑梗死和院内死亡相关的因素。共有 175370 例心内血栓患者入院，其中 10.1%（17675 例）发生脑梗死。心内血栓占主要诊断的 4.4%，而循环系统疾病（65.4%）、感染（5.9%）、胃肠道疾病（4.4%）、呼吸系统疾病（4.4%）和癌症（2.2%）是其他常见的主要诊断。脑梗死患者的全因死亡率更高（8.5%比 4.8%）。与脑梗死最相关的五个因素是肾病综合征（OR 2.67，95%CI 1.05-6.78）、其他血栓形成倾向（OR 2.12，95%CI 1.52-2.95）、原发性血栓形成倾向（OR 1.99，95%CI 1.52-2.53）、既往卒中（OR 1.61，95%CI 1.47-1.75）和高血压（OR 1.41，95%CI 1.27-1.56）。死亡的最强独立预测因素是肝素诱导的血小板减少症（OR 2.45，95%CI 150-4.00）、急性静脉血栓栓塞症（OR 2.03，95%CI 1.78-2.33，p<0.001）、急性心肌梗死（OR 1.95，95%CI 1.72-2.22）、动脉血栓形成（OR 1.75，95%CI 1.39-2.20）和癌症（OR 1.57，95%CI 1.36-1.81）。患有心内血栓的患者存在脑梗死和院内死亡的风险。肾病综合征、血栓形成倾向、既往卒中、高血压和肝素诱导的血小板减少症与脑梗死相关，而急性静脉血栓栓塞症、急性心肌梗死和癌症是死亡的预测因素。
