Calderón-Parra Jorge, Sánchez-Chica Enrique, Asensio-Vegas Ángel, Fernández-Lozano Ignacio, Toquero-Ramos Jorge, Castro-Urda Víctor, Royuela-Vicente Ana, Ramos-Martínez Antonio
Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
Rev Esp Cardiol (Engl Ed). 2019 Oct;72(10):806-812. doi: 10.1016/j.rec.2018.09.003. Epub 2018 Oct 16.
The use of cardiac implantable electronic devices (CIEDs) has expanded in recent years. Infection related to these devices constitutes one of the main complications and is associated with high morbidity, mortality, and financial cost. The aim of this study was to construct a predictive risk score of acquiring CIED infection.
We designed a retrospective, nested case-control study. Both cases and controls belonged to a cohort that included all patients who underwent a CIED-related procedure between January 2009 and December 2015. Cases were defined as patients with infection, and 3 infection-free controls were randomly selected from the cohort for each case included.
During the study period, 2323 procedures were performed. A total of 33 CIED-related infections were identified. Ninety-nine patients were selected as controls. Independent risk factors were the Charlson index (OR, 1.33; 95%CI, 1.07-1.67), oral anticoagulation (OR, 3.51; 95%CI, 1.44-8.54), revision or replacement of a previous device (OR, 2.75; 95%CI, 1.12-6.71) and the presence of more than 2 leads (OR, 3.42; 95%CI, 1.25-9.37). A predictive risk score was generated and denominated CIED-AI (Charlson Index, more than 2 leads/Electrodes, Device revision/replacement, oral Anticoagulation, previous Infection). This score had an area under the receiver operating characteristic curve of 0.79 (95%CI, 0.71-0.88).
The CIED-AI score may help to identify patients at higher risk of infection, who could be candidates for intensive preventive measures.
近年来，心脏植入式电子设备（CIED）的使用有所增加。与这些设备相关的感染是主要并发症之一，且与高发病率、死亡率及经济成本相关。本研究的目的是构建一个CIED感染获得的预测风险评分。
我们设计了一项回顾性巢式病例对照研究。病例和对照均来自一个队列，该队列包括2009年1月至2015年12月期间接受与CIED相关手术的所有患者。病例定义为感染患者，为每个纳入的病例从队列中随机选取3名未感染对照。
在研究期间，共进行了2323例手术。共识别出33例与CIED相关的感染。99名患者被选为对照。独立危险因素包括查尔森指数（OR，1.33；95%CI，1.07 - 1.67）、口服抗凝治疗（OR，3.51；95%CI，1.44 - 8.54）、先前设备的翻修或更换（OR，2.75；95%CI，1.12 - 6.71）以及存在超过2根导线（OR，3.42；95%CI，1.25 - 9.37）。生成了一个预测风险评分并命名为CIED - AI（查尔森指数、超过2根导线/电极、设备翻修/更换、口服抗凝治疗、既往感染）。该评分在受试者工作特征曲线下的面积为0.79（95%CI，0.71 - 0.88）。
CIED - AI评分可能有助于识别感染风险较高的患者，这些患者可能是强化预防措施的候选对象。
