Faculdade de Medicina da Universidade do Porto, Portugal.
Faculdade de Medicina da Universidade do Porto, Portugal; Instituto Nacional de Medicina Legal e Ciências Forenses, I.P, Portugal.
J Forensic Leg Med. 2024 Aug;106:102727. doi: 10.1016/j.jflm.2024.102727. Epub 2024 Jul 29.
Sudden non-cardiac death (SNCD) is a clinical entity comprising deaths lacking previous clinically significant symptoms, and in which the mechanisms of death do not involve the heart. Infection is a major cause of SNCD, particularly in children, and viruses are frequently involved in the disease process. Nevertheless, SNCD of viral infectious causes remains poorly characterized. Thus, a systematic review of the literature describing the association between viral infection and the development of SNCD was performed.
PRISMA statement guidelines were followed in this systematic review. A literature search was conducted across MEDLINE, Scopus and Web of Science databases. Studies considered eligible were autopsy series or cohort studies of sudden death cases, in which evidence of viral disease as a cause of death was demonstrated, along with identification of causative agents.
Twelve studies published between 1996 and 2020 were included in this review. Selected studies were categorized into three groups according to the study population: infants and young children (up to four years of age); presumed sudden infant death syndrome patients; and older individuals (five years of age and older). SNCD with viral implication represents a minority of sudden death cases in all age groups, with infants and young children having a higher prevalence across studies. Respiratory infection was the main cause of viral SNCD, with influenza virus and respiratory syncytial virus being the most commonly identified agents in older individuals, and infants and young children respectively. Disseminated infection, gastrointestinal infection, and meningitis were other identified causes of SNCD in children.
No studies have directly assessed the frequency and causes of viral SNCD. Infants and young children show a considerable, but variable, prevalence of this clinical entity. Wider implementation of post-mortem virological molecular testing may help uncover previously unknown cases. More research into viral SNCD is needed, especially in the adult population.
非心源性猝死（SNCD）是一种临床实体，其特征为死亡前缺乏明显的临床症状，且死亡机制不涉及心脏。感染是 SNCD 的主要原因，尤其是在儿童中，病毒常参与疾病过程。然而，由病毒感染引起的 SNCD 仍未得到充分描述。因此，我们对描述病毒感染与 SNCD 发展之间关系的文献进行了系统回顾。
本系统评价遵循 PRISMA 声明指南。对 MEDLINE、Scopus 和 Web of Science 数据库进行了文献检索。纳入的研究为尸检系列或猝死病例的队列研究，其中有证据表明病毒疾病是死亡的原因，并确定了病原体。
本综述纳入了 1996 年至 2020 年期间发表的 12 项研究。根据研究人群，选择的研究分为三组：婴儿和幼儿（4 岁以下）；疑似婴儿猝死综合征患者；以及年龄较大的个体（5 岁及以上）。具有病毒感染意义的 SNCD 在所有年龄组中都占少数，婴儿和幼儿的患病率在各研究中更高。呼吸道感染是病毒性 SNCD 的主要原因，流感病毒和呼吸道合胞病毒是年龄较大个体中最常发现的病原体，而在婴儿和幼儿中分别是最常见的病原体。播散性感染、胃肠道感染和脑膜炎也是儿童 SNCD 的其他确定病因。
没有研究直接评估病毒性 SNCD 的频率和病因。婴儿和幼儿的这种临床实体具有相当但可变的患病率。更广泛地实施尸检病毒分子检测可能有助于发现以前未知的病例。需要对病毒性 SNCD 进行更多的研究，特别是在成年人群中。
