CC BY-NC-ND 4.0 · Hamostaseologie 2022; 42(04): 261-267
DOI: 10.1055/a-1694-8723
Original Article

Cardiac and Cerebral Arterial Complications of Lemierre Syndrome: Results from a Systematic Review and Individual Patient Data Meta-analysis

William Pleming
1   Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
,
Stefano Barco
1   Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
2   Center for Thrombosis and Hemostasis, Mainz University Medical Center, Mainz, Germany
,
Davide Voci
1   Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
,
Clara Sacco
3   Center for Thrombosis and Hemorrhagic Diseases, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
,
Federica Zane
4   Department of General Medicine, Hospital of Sondrio, Sondrio, Italy
,
Serena Granziera
5   Department of Medicine, Geriatric Unit, Ospedale San Giovanni e Paolo, Venice, Italy
,
Gabriele Corsi
6   Department of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit, S. Orsola - Malpighi Hospital, Alma Mater University, Bologna, Italy
7   IRCCS Azienda Ospedaliero - Universitaria of Bologna, Bologna, Italy
,
Stavros V. Konstantinides
2   Center for Thrombosis and Hemostasis, Mainz University Medical Center, Mainz, Germany
,
Nils Kucher
1   Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
,
Alessandro Pecci
8   Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
,
2   Center for Thrombosis and Hemostasis, Mainz University Medical Center, Mainz, Germany
› Author Affiliations

Abstract

Background Lemierre syndrome is a potentially life-threatening disease, which affects otherwise healthy young adults and adolescents. It is characterized by acute neck vein thrombosis and septic embolism, usually complicating a bacterial infection. Data on the syndrome are sparse, particularly concerning arterial complications.

Methods We evaluated the frequency and patterns of cerebral arterial and cardiac involvement (“arterial complications”) in an individual patient level cohort of 712 patients, representing all cases described over the past 20 years in the medical literature who fulfilled the criteria: (1) bacterial infection in the neck/head site and (2) objectively confirmed thrombotic complication or septic embolism. The study outcomes were defined as all-cause in-hospital deaths and the occurrence of clinical sequelae at discharge or in the postdischarge period.

Results A total of 55 (7.7%) patients had an arterial complication. The most frequent arterial complications were carotid involvement (52.7%), stroke (38.2%), and pericardial complications (20%). Patients with an arterial involvement were more likely to be treated with a greater number of antibiotics (23 vs. 10%) and to receive anticoagulation. In addition, patients with arterial complications had a greater risk of all-cause death (n = 20/600, 3.3% vs. n = 6/52, 12%; odds ratio [OR]: 3.8; 95% confidence interval [CI]: 1.5–9.9) and late clinical sequelae (n = 49/580, 9.0% vs. n = 15/46, 35%; OR: 5.2; 95% CI: 2.65–10.37).

Conclusions While Lemierre syndrome is known to be primarily characterized by venous thromboembolic events, our results suggest that local or distant arterial complications may occur in approximately one-tenth of patients and may be associated with a greater risk of long-term sequelae and death.



Publication History

Received: 18 June 2021

Accepted: 10 November 2021

Article published online:
07 March 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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