Aniekeme Etuk, Goncalves Bruno, Pillai Sneha, Soji-Ayoade Demilade, Sodhi Komal, Rueda Rios Carlos, Thompson Ellen
Department of Cardiology, Marshall University Joan C. Edwards School of Medicine, Huntington, USA.
Department of Biomedical Sciences, Marshall University Joan C. Edwards School of Medicine, Huntington, USA.
Cureus. 2025 Apr 9;17(4):e81958. doi: 10.7759/cureus.81958. eCollection 2025 Apr.
Introduction Carcinoid syndrome (CS) represents the most common functional syndrome in patients with neuroendocrine tumors which may be in an advanced tumor state. The pathophysiology of congestive heart failure (CHF) and arrhythmia in CS is poorly understood; however, chronic exposure to excessive circulating serotonin is considered one of the most important factors contributing to increased morbidity and mortality in this population. Despite recognition, international consensus guidelines specifically addressing the diagnosis and management of CHF and arrhythmia in CS are lacking. This study focused on hospitalized patients once they represent more severe disease states requiring intensive management, thereby providing a clearer understanding of factors influencing adverse clinical outcomes. Methods This retrospective cohort study utilized the Healthcare Cost and Utilization Project National Inpatient Sample to identify predictors of congestive heart failure and arrhythmia in hospitalized CS patients from 2016 to 2018. Results Initially, a total of 1,859 patients were included. After stratification, 606 patients had CHF and arrhythmia diagnosis with variables analyzed using multivariate logistic regression. Among 606 patients, 360 had CHF with advanced age, male sex, non-Hispanic Black race, Medicare insurance, and prolonged hospital stays, all of which were identified as significant predictors. Similarly, 246 patients diagnosed with arrhythmias were more prevalent in older and male patients and were associated with increased mortality and prolonged hospitalization. Conclusion These results highlight critical patient-related factors influencing mortality in CS patients with CHF and arrhythmia. Strategies aimed at early recognition, including clinical scoring systems, and biomarker assessment, could improve risk stratification and patient outcomes. Our findings underscore the importance of early risk stratification and targeted interventions to mitigate cardiac complications in CS patients. Additionally, incorporating our data into clinical practice has the potential to improve early recognition, promoting timely interventions for CS patients with CFH and arrhythmia. Developing consensus guidelines for managing CS-related cardiac complications, based on these insights, will further standardize care and improve patient outcomes.
引言 类癌综合征（CS）是神经内分泌肿瘤患者中最常见的功能性综合征，这些患者的肿瘤可能处于晚期。CS 中充血性心力衰竭（CHF）和心律失常的病理生理学尚不清楚；然而，长期暴露于过量循环的血清素被认为是导致该人群发病率和死亡率增加的最重要因素之一。尽管已得到认可，但缺乏专门针对 CS 中 CHF 和心律失常的诊断和管理的国际共识指南。本研究聚焦于住院患者，因为他们代表了需要强化管理的更严重疾病状态，从而能更清楚地了解影响不良临床结局的因素。
方法 这项回顾性队列研究利用医疗成本和利用项目国家住院样本，以确定 2016 年至 2018 年住院 CS 患者中充血性心力衰竭和心律失常的预测因素。
结果 最初，共纳入 1859 名患者。分层后，606 名患者被诊断为 CHF 和心律失常，并使用多因素逻辑回归分析变量。在 606 名患者中，360 名患有 CHF，高龄、男性、非西班牙裔黑人种族、医疗保险和住院时间延长均被确定为显著预测因素。同样，246 名被诊断为心律失常的患者在老年男性患者中更为普遍，且与死亡率增加和住院时间延长有关。
结论 这些结果突出了影响 CS 合并 CHF 和心律失常患者死亡率的关键患者相关因素。旨在早期识别的策略，包括临床评分系统和生物标志物评估，可改善风险分层和患者结局。我们的研究结果强调了早期风险分层和针对性干预以减轻 CS 患者心脏并发症的重要性。此外，将我们的数据纳入临床实践有可能改善早期识别，促进对患有 CFH 和心律失常的 CS 患者的及时干预。基于这些见解制定 CS 相关心脏并发症管理的共识指南，将进一步规范治疗并改善患者结局。
