Key result
End stage renal disease with dialysis (OR 5.14; 95% CI 1.87-14.11) and thrombocytopenia (OR 2.3; 95% CI 1.03-5.15) were significant predictors of 1-year mortality in patients with CIED infections.
Why the study?
Cardiac implantable electronic device infections are linked to high mortality, motivating the identification of key survival predictors to detect high-risk patients and address modifiable factors.
Observational (n=277)
No
End stage renal disease with dialysis and preoperative thrombocytopenia are strong predictors of 1-year mortality in patients with CIED infections, identifying a high-risk subgroup that requires critical evaluation.
ESRD on dialysis and thrombocytopenia flag high-risk CIED infection patients; leaves open whether targeted interventions improve survival.
INTRODUCTION: Cardiac implantable electronic device (CIED) infections are associated with a high mortality. Our aim was to identify key predictors of survival in patients with CIED infections as to be able to detect high-risk patients and possibly affect modifiable factors. METHODS AND RESULTS: In this observational study, we collected data from 277 patients with CIED infections treated in our department between 2001 and 2017; predictors of survival were evaluated. The median time since the last CIED procedure was 0.83 years (interquartile range [IQR]: 0.25-3.01), median time since initial CIED implant was 4.79 years (IQR: 0.90-11.0 years). Survival at 30 days was 94.9% (95% confidence interval [CI]: 92.3-97.5) and survival at 1 year was 80.9% (CI: 76.4-85.7). Age (odds ratio [OR]: 1.05, CI: 1.01-1.09; P = .009), end stage renal disease (ESRD) with dialysis (OR: 5.14, CI: 1.87-14.11; P = .001), positive blood cultures (OR: 2.19, CI: 1.08-4.45; P = .030), and thrombocytopenia (OR: 2.3, CI, 1.03-5.15; P = .042) were identified as predictors of death within 1 year of treatment of CIED infection. CONCLUSION: Patients with CIED infection with prior ESRD with dialysis or preoperative thrombocytopenia are at an increased risk of 1-year mortality. We suggest that these patients be evaluated critically and resources be allocated to these patients more liberally. A greater understanding of the role of platelets in immunity may improve treatment of advanced infection in the future.
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Herrmann et al. (2019) conducted an observational in Cardiac implantable electronic device (CIED) infections (n=277). End stage renal disease (ESRD) with dialysis and thrombocytopenia vs. Patients without these risk factors was evaluated on Death within 1 year of treatment of CIED infection (OR 5.14, 95% CI 1.87-14.11, p=.001). End stage renal disease with dialysis (OR 5.14; 95% CI 1.87-14.11) and thrombocytopenia (OR 2.3; 95% CI 1.03-5.15) were significant predictors of 1-year mortality in patients with CIED infections.
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