Predictors of short-term mortality in patients undergoing a successful uncomplicated extraction procedure.
Adult
Aged
Aged, 80 and over
Biomarkers
/ blood
Creatinine
/ blood
Databases, Factual
Defibrillators, Implantable
/ adverse effects
Device Removal
/ adverse effects
Female
Humans
Male
Middle Aged
Pacemaker, Artificial
/ adverse effects
Prosthesis Failure
Prosthesis-Related Infections
/ diagnosis
Retrospective Studies
Risk Assessment
Risk Factors
Serum Albumin, Human
/ analysis
Time Factors
Treatment Outcome
albumin
creatinine
infection
lead extraction
mortality
risk score
Journal
Journal of cardiovascular electrophysiology
ISSN: 1540-8167
Titre abrégé: J Cardiovasc Electrophysiol
Pays: United States
ID NLM: 9010756
Informations de publication
Date de publication:
05 2020
05 2020
Historique:
received:
20
11
2019
revised:
20
01
2020
accepted:
31
01
2020
pubmed:
7
3
2020
medline:
13
4
2021
entrez:
7
3
2020
Statut:
ppublish
Résumé
The prognosis of patients with untreated cardiac implantable electronic device (CIED) infection is poor. Whether removal of all leads by a successful transvenous lead extraction (TLE) procedure changes the prognosis is unclear. To identify predictors of mortality in patients with CIED infection despite successful TLE. Retrospective single-center analysis of prospectively collected database from consecutive patients undergoing TLE at our center. Predictors for mortality were identified and a score predicting high mortality rate was calculated. A total of 371 consecutive patients underwent TLE, of whom 337 (90.8%) had complete hardware removal. Most were extracted due to infectious causes (81.3%). Approximately one-third (35%) died during a mean follow-up of 1056 ± 868 days. There was significantly higher mortality observed in the infectious group. Multivariate logistic regression models for infectious group only identified creatinine and albumin measurements as risk markers for 30 days mortality (odds ratio [OR], 1.68; 95% confidence interval [CI], 1.19-2.38; P = .003 and OR, 0.4; 95% CI, 0.16-0.97; P = .039, respectively). A risk score was created based on cutoff values of creatinine ≥2md/dL (1 point) and albumin ≤3.5 g/dL (1 point). A value of 2 points predicted a 50% chance of 30-day mortality and a 75% chance of 1-year mortality (P < .0001 for both). Creatinine and albumin can be used as a combined risk score to successfully identify patients at risk of death despite undergoing a successful TLE procedure for infectious reasons. This score could help decision making when contemplating on conservative antibiotic treatment vs TLE.
Sections du résumé
BACKGROUND
The prognosis of patients with untreated cardiac implantable electronic device (CIED) infection is poor. Whether removal of all leads by a successful transvenous lead extraction (TLE) procedure changes the prognosis is unclear.
OBJECTIVE
To identify predictors of mortality in patients with CIED infection despite successful TLE.
METHODS
Retrospective single-center analysis of prospectively collected database from consecutive patients undergoing TLE at our center. Predictors for mortality were identified and a score predicting high mortality rate was calculated.
RESULTS
A total of 371 consecutive patients underwent TLE, of whom 337 (90.8%) had complete hardware removal. Most were extracted due to infectious causes (81.3%). Approximately one-third (35%) died during a mean follow-up of 1056 ± 868 days. There was significantly higher mortality observed in the infectious group. Multivariate logistic regression models for infectious group only identified creatinine and albumin measurements as risk markers for 30 days mortality (odds ratio [OR], 1.68; 95% confidence interval [CI], 1.19-2.38; P = .003 and OR, 0.4; 95% CI, 0.16-0.97; P = .039, respectively). A risk score was created based on cutoff values of creatinine ≥2md/dL (1 point) and albumin ≤3.5 g/dL (1 point). A value of 2 points predicted a 50% chance of 30-day mortality and a 75% chance of 1-year mortality (P < .0001 for both).
CONCLUSIONS
Creatinine and albumin can be used as a combined risk score to successfully identify patients at risk of death despite undergoing a successful TLE procedure for infectious reasons. This score could help decision making when contemplating on conservative antibiotic treatment vs TLE.
Substances chimiques
ALB protein, human
0
Biomarkers
0
Creatinine
AYI8EX34EU
Serum Albumin, Human
ZIF514RVZR
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1155-1162Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2020 Wiley Periodicals, Inc.
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