Why the study?
Diagnosing CIED-related infections is often difficult and requires complex imaging and microbiological tests, creating a need to evaluate whether simple hematological parameters can detect these complications and assess their extent.
Do novel hematological parameters (NLR, NPR, LPR) improve the diagnosis and assessment of the extent of CIED-related infections in patients undergoing transvenous lead extraction?
Do novel hematological parameters (NLR, NPR, LPR) improve the diagnosis and assessment of the extent of CIED-related infections in patients undergoing transvenous lead extraction?
Novel hematological markers like NLR and NPR may serve as simple, specific tools to aid in diagnosing and assessing the extent of CIED-related infections.
Answers are grounded in this paper and cite their sources.
NLR and NPR may aid CIED infection assessment; hypothesis-generating and requires prospective validation before practice change.
Background: Patients with infectious complications related to the presence of cardiac implantable electronic devices (CIED) constitute a heterogeneous group, including local pocket infection (PI) and lead related infectious endocarditis (LRIE). The diagnosis of CIED-related infection is often difficult and requires complex imaging and microbiological tests. The aim of the current study was to evaluate the usefulness of new simple hematological parameters in detecting infectious complications in patients with CIED and assessing their extent. Methods: The retrospective analysis of clinical data of 2909 patients (36.37% with CIED-related infections), undergoing transvenous lead extraction (TLE) procedures in three high-volume centres in the years 2006-2020, was conducted. The sensitivity and specificity of new hematological markers were evaluated: the neutrophil to lymphocyte ratio (NLR), neutrophil to platelet ratio (NPR), and lymphocyte to platelet ratio (LPR) in the diagnosis of infectious complications, assessment of the spread of the infectious process and differentiation of additional structures related to the presence of leads. Results: In patients with CIED infections, compared to the non-infectious group, high inflammatory parameters were confirmed, and the highest specificity of the new markers in detecting the infectious process was demonstrated. (79.47% for NPR and 72.82% for NLR). Analysis of laboratory parameters in infectious and non-infectious patients with the presence of additional lead-related masses showed the highest specificity of NPR (82,78%) in predicting the diagnosis of vegetation. Comparison of laboratory parameters in patients with LRIE and PI showed higher NLR % (4.24 vs 2.56; p<0.001, area under curve (AUC) in a receiver operating characteristic (ROC) curve: 0.67 and 0.78 respectively) and higher NPR (0.03 vs 0.02; p<0.001; AUC: 0,51 and 0,55) in patients with LRIE. The highest sensitivity in the detection of coexistence LRIE with PI has been demonstrated for NLR (87.33%). Conclusions: Novel hematological markers may be helpful in the recognition of the inflammatory process in patients with CIED, differentiation of vegetation and vegetation-like masses, and the extent of infection in patients with PI.
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Polewczyk et al. (2023) studied this question.
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