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14 years), plus one additional unpublished case managed in Tongji hospital.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.

中文翻译：

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脂肪栓塞综合征的单例荟萃分析

背景

只有一个大型系列报道了脂肪栓塞综合征 (FES)，这是一种由脂肪球释放到循环中引起的疾病，主要是骨折的结果。因此，需要更多关于临床特征、治疗和预后的数据。

方法和结果

该研究在 PubMed 和 Web of Science 上筛选了 2010 年 6 月至 2020 年 6 月发表的关于 FES 病例的 1090 篇手稿。作者确定了 124 项研究，并在汇总分析中纳入了 135 名患者（>14 岁），另外还有一个未发表的病例在同济医院。所有人都通过完整的临床数据确认了 FES 的诊断。就诊时的中位年龄为 39 岁，其中 82 人（61.8%）为男性。FES 主要与骨折相关（78, 57.4%），尤其是股骨骨折（59, 43.4%）。发病时最常见的临床表现是呼吸异常，占所有临床表现的 34.6%。治疗包括 127 例 (93.4%) 患者的呼吸支持治疗、22 例 (16.2%) 患者使用皮质类固醇和 5 例 (3.7%) 患者使用抗凝剂。总死亡率为 30.2%（N = 41)，逻辑回归分析显示皮质类固醇治疗与死亡率降低显着相关，OR 为 0.143 (95%CI 0.029–0.711)，而年龄 ≥ 65 岁和非骨科疾病与死亡率增加显着相关OR 为 4.816 (95%CI 1.638–14.160) 和 4.785 (95%CI 1.019–22.474)。

结论

FES 与比以前观察到的更高的死亡率相关，尽管发表偏倚可能导致对死亡率的高估。最后，目前的分析表明皮质类固醇治疗具有潜在的保护作用。