Key result
PADIT risk score successfully stratifies patients for 1-year device infection risk with a ~0.70 C-statistic.
Why the study?
Cardiac implantable electronic device infection is a major complication usually requiring device removal, motivating the identification of independent predictors and development of a novel infection risk score.
What are the independent predictors of cardiac implantable electronic device infection, and can a risk score be developed to stratify patients?
RCT (n=19,603)
Blinded endpoint adjudication
Cluster crossover
Yes
What are the independent predictors of cardiac implantable electronic device infection, and can a risk score be developed to stratify patients?
Effect estimate: C-statistic 0.704 (95% CI 0.660 to 0.744)
The PADIT risk score uses 5 readily available clinical variables to effectively stratify patients' risk of CIED infection, aiding in clinical decision-making.
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Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“It's very easy for patients to get to a PADIT score of 7 or higher. [For example] an 85-year-old with renal dysfunction who is under consideration for a second replacement of an implantable cardioverter defibrillator... the consequent 3.4% risk for infection might counterbalance the potential benefit this elderly patient could expect from the new device.”
“I think this risk score will change practice by giving clinicians a better idea of a patient's risk for infection.”
May support preoperative counseling in CIED recipients; leaves open whether score-guided interventions reduce infections.
Birnie et al. (2019) conducted an RCT in Cardiac implantable electronic device infection (n=19,603). Incremental prophylactic antibiotics vs. Conventional prophylactic antibiotics was evaluated on Hospitalization for device infection within 1 year (C-statistic 0.704, 95% CI 0.660 to 0.744). The PADIT risk score, incorporating 5 independent predictors, successfully stratified patients for 1-year device infection risk with an optimism-corrected C-statistic of 0.704 (95% CI 0.660-0.744).
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