The Meta Analysis Of Infective Endocarditis In Chinese Children

Objective: A meta-analysis was conducted to summarize Chinese children estimates of the clinical characteristics, complications, treatment and outcomes of infective endocarditis by R statistical software.Methods: Four main electronic databases(Wan Fang database, VIP database,China National Knowledge Infrastructure and Pub Med database) was systematically and inclusively searched for all IE studies with Chinese children through March 2016. A Meta-analysis was conducted by using R.3.2.2. Heterogeneity was tested by using the Q statistic. Pooled values and 95% CIs were generated from a fixed-effects model or from a random-effects model according to statistical tests for heterogeneity. Publication bias was assessed by using the Egger’s regression test, meta-regression and subgroup analyses were employed to examine the effect of study-level variables.Results: Sixteen studies were selected with a total of 892 IE, the pooled proportion of male was 55%(95%CI:51%-58%). Preexisting heart diseases were reportedly the most important risk factor for IE in children. The pooled proportion of IE with CHD was 68%(95%CI:62%-72%),and 33%(95%CI:27%-40%) was VSD. The pooled rate of IE with RHD was 10%(95%CI:7%-14%). The most common clinical manifestation was fever(89%[95%CI:84%-93%]). Other clincal features included changed heart murmur,splenomegaly,ecchymosis and so on. The pooled rates of embolism and heart failure were 22%(95%CI:19%-26%) and 45%(95%CI:34%-56%). Among positive blood culture,the pooled rate of gram-positive bacterium was 87%(95%CI:83%-90%), followed by gram-negative bacterium(9%[95%CI:7%-13%]) and fungus(5%[95%CI:3%-8%]).The pooled proportion of vegetations was 78%(95%CI:67%-86%).The pooled rates of left heart and right heart were affected in 60%(95%CI:43%-75%) and 33%(95%CI:21%-48%). The pooled proportion of case-children with surgical treatment was 21%(95%CI:13%-32%).The pooled case-fatality rate for IE was 14%(95%CI:10%-18%),and it was different from place to place.Conclusion:Pediatric IE was a rare and potentially life-threatening infection. IE was associated with significant mortality in children,and the case-fatality rate for it could vary depending on the area. CHD was the major risk factor for IE, however, RHD was also an important risk factor. Staphylococcus aureus was the main pathogens of the cases of IE. The left heart was affected in more episodes than the right heart. Clinical manifestations of IE were less typical, and early diagnosis depended on the blood culture and ultrasound examination.