From the Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center-Houston and Memorial Hermann-Texas Medical Center, Houston, Texas.
Advanced Heart Failure and Transplantation Center, University Medical Center Ljubljana, Ljubljana, Slovenia.
ASAIO J. 2019 Sep/Oct;65(7):678-682. doi: 10.1097/MAT.0000000000000916.
In patients with left ventricular assist devices (LVADs), the association of driveline infection (DLI) and body mass index (BMI) remains controversial. The aim of this study was to explore a potential correlation between BMI and DLI in the LVAD patient population. A retrospective, single-center study evaluated patients who underwent LVAD implantation between May 2012 and July 2016. Driveline infection was evaluated per Interagency Registry for Mechanically Assisted Circulatory Support established criteria. Of 222 included patients, 80% were male, the average age was 55 years, and the main underlying heart failure diagnosis was nonischemic cardiomyopathy (56%). The majority of patients (65%) received LVAD as destination therapy and 35% as a bridge to transplantation. Average time-to-first DLI was 296 days after LVAD implantation. In comparison to non-DLI group (80%, N = 177), patients in DLI group (20%, N = 45) had a higher BMI (33.5 ± 8.3 kg/m in DLI group vs. 28.8 ± 7.5 kg/m in non-DLI group, p = 0.0003) and were younger (51 ± 12 years in DLI group vs. 56 ± 12 years in non-DLI group, p = 0.013). There was a significant correlation between BMI and DLI (p < 0.0001), and age was negatively correlated with DLI (p = 0.01). Analysis revealed no correlation between time-to-first DLI and BMI. Our data confirm that higher BMI is associated with increased prevalence of DLI in LVAD population, particularly in younger patients. Addressing excessive body weight in this patient cohort may significantly reduce DLI and thereby improve long-term outcomes.
在接受左心室辅助装置（LVAD）治疗的患者中，与体重指数（BMI）相关的血流感染（DLI）仍存在争议。本研究旨在探讨 LVAD 患者人群中 BMI 与 DLI 之间的潜在相关性。一项回顾性单中心研究评估了 2012 年 5 月至 2016 年 7 月期间接受 LVAD 植入的患者。根据机械循环辅助支持机构间注册处建立的标准评估 DLI。在纳入的 222 例患者中，80%为男性，平均年龄为 55 岁，主要的心力衰竭诊断为非缺血性心肌病（56%）。大多数患者（65%）接受 LVAD 作为终末期治疗，35%作为移植桥接。LVAD 植入后首次发生 DLI 的平均时间为 296 天。与非 DLI 组（80%，N=177）相比，DLI 组（20%，N=45）患者的 BMI 更高（DLI 组 33.5±8.3kg/m2，非 DLI 组 28.8±7.5kg/m2，p=0.0003），且年龄更小（DLI 组 51±12 岁，非 DLI 组 56±12 岁，p=0.013）。BMI 与 DLI 之间存在显著相关性（p<0.0001），年龄与 DLI 呈负相关（p=0.01）。分析显示，首次发生 DLI 的时间与 BMI 之间无相关性。我们的数据证实，较高的 BMI 与 LVAD 人群中 DLI 的发生率增加相关，尤其是在年轻患者中。在该患者队列中解决体重过重的问题可能会显著降低 DLI 的发生率，从而改善长期预后。
