Neurologic Complications of Fat Embolism Syndrome.

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Abstract

[Indexed for MEDLINE] 5. Int J Cardiol. 2021 Dec 15;345:111-117. doi: 10.1016/j.ijcard.2021.10.151. Epub 2021 Oct 30. Single-case metanalysis of fat embolism syndrome. He Z(1), Shi Z(2), Li C(2), Ni L(1), Sun Y(1), Arioli F(3), Wang Y(1), Ammirati E(4), Wang DW(5). Author information: (1)Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiological Disorders, Wuhan, China. (2)Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiological Disorders, Wuhan, China. (3)Department of Cardiology, Fatebenefratelli Hospital, Milano, Italy. (4)De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy. Electronic address: enrico.ammirati@ospedaleniguarda.it. (5)Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiological Disorders, Wuhan, China. Electronic address: dwwang@tjh.tjmu.edu.cn. Comment in Int J Cardiol. 2022 Feb 1;348:126-127. doi: 10.1016/j.ijcard.2021.11.081. BACKGROUND: Only one large series has been reported on fat embolism syndrome (FES), a condition caused by fat globules release into the circulation, primarily as consequence of bone fracture. Thus, more data on clinical features, therapies, and prognosis are needed. METHODS AND RESULTS: The study screened 1090 manuscripts in PubMed and Web of Science on cases of FES published from June 2010 to June 2020. The authors identified 124 studies and included in the pooled-analysis 135 patients (>14 years), plus one additional unpublished case managed in Tongji hospital. All had confirmed diagnosis of FES with complete clinical data. The median age at presentation was 39 years, and 82 (61.8%) were men. FES was predominantly associated with bone fractures (78, 57.4%), particularly femur fracture (59, 43.4%). The most common clinical finding at the onset was respiratory abnormalities in 34.6% of all clinical presentations. Therapies included respiratory supportive care in 127 (93.4%) patients, application of corticosteroids in 22 (16.2%) and anticoagulant in 5 (3.7%) cases. Overall mortality was 30.2% (N = 41), and logistic regression analysis showed that corticosteroid therapy was significantly associated with reduced mortality with an OR of 0.143 (95%CI 0.029-0.711), while age ≥ 65 years and non-orthopedic conditions were significantly associated with increased mortality with an OR of 4.816 (95%CI 1.638-14.160) and 4.785 (95%CI 1.019-22.474). CONCLUSIONS: FES has been associated with a larger mortality rate than previously observed, although publication bias can have led to overestimation of mortality. Finally, a potential protective effect of corticosteroid therapy has been suggested by the current analysis. Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved. DOI: 10.1016/j.ijcard.2021.10.151