Alhuarrat Majd Al Deen, Garg Vibhor, Borkowski Pawel, Nazarenko Natalia, Alhuarrat Mohammad Rasoul, Abushairah Ayman, Al Zyoud Batool, Bitsis Exarchos-Marios, Barzallo Diego, Alemu Rebeca, Kharawala Amrin, Nagraj Sanjana, Abdou Claudine, Faillace Robert T, Rai Devash, Minuti Aurelia, Palaiodimos Leonidas
Department of Medicine, NYC Health + Hospitals/ Jacobi, Albert Einstein College Medicine, Bronx, NY.
Department of Medicine, NYC Health + Hospitals/ Jacobi, Albert Einstein College Medicine, Bronx, NY.
Curr Probl Cardiol. 2024 Jan;49(1 Pt A):102027. doi: 10.1016/j.cpcardiol.2023.102027. Epub 2023 Aug 7.
Nonbacterial thrombotic endocarditis (NBTE) is a distinctive condition marked by the presence of aseptic fibrin depositions on cardiac valves due to hypercoagulability and endocardial damage. There is a scarcity of large cohort studies clarifying factors associated with morbidity and mortality of this condition. A systematic literature review was performed utilizing the PubMed, Embase, Cochrane, and Web-of-Science databases to retrieve case reports and series documenting cases of NBTE from inception until September-2022. A descriptive analysis of basic characteristics was carried out, followed by multivariate regression analysis to identify risk factors associated with morbidity and mortality. A total of 416 case reports and series were identified, of which 450 patients were extracted. The female-to-male ratio was around 2:1 with an overall sample median age of 48 (interquartile range [IQR]:34-61). Stroke-like symptoms were the most common presentation and embolic phenomena occurred in 70% of cases, the majority of which were due to stroke. Cancer was associated with higher embolic complications (aOR:6.38, 95% CI = 3.75-10.83, p < 0.01) in comparison to other NBTE etiologies, while age, sex, and vegetation size were not (p > 0.05). All-cause in-hospital mortality was 36%, with cancer etiology being associated with higher mortality: 56% (aOR:3.64, 95% CI = 1.57-8.43, p < 0.01) in comparison to other NBTE etiologies:19%. A significant decrease in NBTE mortality was seen in recent years in comparison to admissions that occurred during the 20th century (aOR:0.07, 95% CI = 0.04-0.15, p < 0.01). While there has been an observed improvement in overall in-hospital mortality rates for patients admitted with NBTE in recent years, it is important to note that cases associated with a cancer etiology are still linked to high morbidity and mortality during hospitalization.
非细菌性血栓性心内膜炎（NBTE）是一种独特的病症，其特征是由于高凝状态和心内膜损伤，在心脏瓣膜上存在无菌性纤维蛋白沉积。目前缺乏大型队列研究来阐明与该病症发病率和死亡率相关的因素。利用PubMed、Embase、Cochrane和Web of Science数据库进行了系统的文献综述，以检索从开始到2022年9月记录NBTE病例的病例报告和系列研究。对基本特征进行了描述性分析，随后进行多变量回归分析以确定与发病率和死亡率相关的危险因素。共识别出416份病例报告和系列研究，从中提取了450名患者。女性与男性的比例约为2:1，总体样本中位年龄为48岁（四分位间距[IQR]：34 - 61）。类似中风的症状是最常见的表现，70%的病例出现栓塞现象，其中大多数是由于中风。与其他NBTE病因相比，癌症与更高的栓塞并发症相关（调整后比值比[aOR]：6.38，95%置信区间[CI] = 3.75 - 10.83，p < 0.01），而年龄、性别和赘生物大小则不然（p > 0.05）。全因住院死亡率为36%，癌症病因与更高的死亡率相关：与其他NBTE病因（19%）相比为56%（aOR：3.64，95% CI = 1.57 - 8.43，p < 0.01）。与20世纪的入院病例相比，近年来NBTE死亡率显著下降（aOR：0.07，95% CI = 0.04 - 0.15，p < 0.01）。虽然近年来观察到NBTE患者总体住院死亡率有所改善，但需要注意的是，与癌症病因相关的病例在住院期间仍与高发病率和死亡率相关。
