暴发性心肌炎患者院内死亡的相关因素：系统综述与荟萃分析。
完整摘要 · 中文译文
背景：暴发性心肌炎（FM）进展迅速，全因院内死亡率高。早期患者常出现心源性休克和恶性室性心律失常，各研究报告的死亡率差异很大。现有单中心队列的预后研究结果相互矛盾，队列间异质性显著，且尚无采用GRADE证据确定性分级的标准化荟萃分析来指导风险分层。本荟萃分析汇总了FM全因院内死亡率的预后关联，以期为急性风险评估和个体化诊疗提供依据。 方法：检索11个中英文电子数据库，检索时间自建库至2025年6月。纳入的研究为报告FM患者全因院内死亡率预后关联的观察性队列研究。由两名独立评价员分别完成筛选、数据提取和质量评价。采用纽卡斯尔-渥太华量表（NOS）和AHRQ清单评估方法学质量。采用Python中的statsmodels包进行合并分析，并应用GRADE框架对证据确定性进行分级。 结果：共纳入26项回顾性队列研究，涵盖4，890例FM患者。对10个潜在因素进行了荟萃分析，其中6个因素与院内死亡率存在统计学显著关联（P < 0.05），包括年龄（OR = 1.03，95% CI：1.02-1.04）、心脏骤停或心肺复苏（OR = 2.57，95% CI：1.49-4.44）、乳酸（OR = 1.08，95% CI：1.00-1.16）、cTnI（OR = 1.04， 95% CI：1.01-1.07）、左心室射血分数（LVEF）（OR 0.94，95% CI 0.90-0.97）和静脉注射免疫球蛋白治疗（OR = 0.12，95% CI：0.02-0.86）。CK-MB、血清肌酐、总胆红素和室性心动过速/心室颤动（VT/VF）未显示具有统计学意义的关联（均P > 0.05）。GRADE证据评级显示，年龄和心肌肌钙蛋白I（cTnI）为低确定性证据，其余显著因素为极低确定性证据。敏感性分析显示，乳酸和静脉注射免疫球蛋白治疗的合并估计值不稳定。 结论：四个因素与全因院内死亡率升高呈正相关。LVEF与死亡率呈负相关，而静脉注射免疫球蛋白（IVIG）的负相关代表一个脆弱的治疗相关信号。这些发现可为急性风险筛查提供参考，但大多数关联仅得到低或极低确定性证据的支持，不应被解释为因果关系。所有纳入数据均来自回顾性队列。需要标准化的多中心前瞻性研究来验证这些预后关联。 系统综述注册：https://www.crd.york.ac.uk/PROSPERO/view/CRD420261399446，注册号CRD420261399446。
完整摘要 · 英文原文
BACKGROUND: Fulminant myocarditis (FM) progresses rapidly and carries high all-cause in-hospital mortality. Patients in the early phase often develop cardiogenic shock and malignant ventricular arrhythmias, with widely varying mortality rates reported across studies. Existing single-center cohorts yield conflicting prognostic findings with marked cross-cohort heterogeneity, and no standardized meta-analysis with GRADE certainty grading has been published to guide risk stratification. This meta-analysis pooled prognostic associations of all-cause in-hospital mortality in FM to inform acute risk evaluation and personalized care. METHODS: Eleven Chinese and English electronic databases were searched from database establishment through June 2025. Eligible studies were observational cohorts reporting prognostic associations of all-cause in-hospital mortality among FM patients. Two independent reviewers completed screening, data extraction and quality assessment separately. The Newcastle-Ottawa Scale (NOS) and AHRQ checklist were adopted to evaluate methodological quality. Pooled analyses were performed via the statsmodels package in Python, and the GRADE framework was applied to rate the certainty of evidence. RESULTS: 26 retrospective cohort studies with 4,890 FM patients were enrolled. Ten potential factors were meta-analyzed, of which six showed statistically significant associations with in-hospital mortality (P < 0.05), including age (OR = 1.03, 95% CI: 1.02-1.04), cardiac arrest or CPR (OR = 2.57, 95% CI: 1.49-4.44), lactate (OR = 1.08, 95% CI: 1.00-1.16), cTnI (OR = 1.04, 95% CI: 1.01-1.07), LVEF (OR 0.94, 95% CI 0.90-0.97), and intravenous immunoglobulin therapy (OR = 0.12, 95% CI: 0.02-0.86). CK-MB, serum creatinine, total bilirubin, and VT/VF showed no statistically significant association (all P > 0.05). GRADE evidence ratings indicated low-certainty evidence for age and cTnI, and very-low-certainty evidence for the remaining significant factors. Sensitivity analyses indicated unstable pooled estimates for lactate and intravenous immunoglobulin therapy. CONCLUSIONS: Four factors showed positive associations with elevated all-cause in-hospital mortality. LVEF was inversely associated with mortality, whereas the inverse association for IVIG represents a fragile treatment-related signal. These findings may inform acute risk screening, but most associations were supported by low or very low certainty evidence and should not be interpreted as causal. All included data were derived from retrospective cohorts. Standardized multicenter prospective studies are required to verify these prognostic associations. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261399446, identifier CRD420261399446.