Lacharite-Roberge Anne-Sophie, Toomu Sandeep, Aldaas Omar, Ho Gordon, Pollema Travis L, Birgersdotter-Green Ulrika
Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Diego, San Diego, California.
Division of Cardiovascular and Thoracic Surgery, University of California San Diego, San Diego, California.
Heart Rhythm O2. 2024 Apr 15;5(5):289-293. doi: 10.1016/j.hroo.2024.04.007. eCollection 2024 May.
Cardiovascular implantable electronic device (CIED) infections are a common indication for device extraction. Early diagnosis and complete system removal are crucial to reduce morbidity and mortality. The lack of clear infectious symptoms makes the diagnosis of pocket infections challenging and may delay referral for extraction.
We aimed to determine if inflammatory biomarkers can help diagnose CIED isolated pocket infection.
We performed a retrospective analysis of all patients undergoing transvenous lead extraction for CIED infection at the University of California San Diego from 2012 to 2022 (N = 156). Patients were classified as systemic infection (n = 88) or isolated pocket infection (n = 68). Prospectively collected preoperative procalcitonin (PCT), C-reactive protein, and white blood cell count were compared between groups.
Pairwise comparisons revealed that the systemic infection group had a higher PCT than the control group ( .001) and the pocket infection group ( .009). However, there was no significant difference in PCT value between control subjects and isolated pocket infection subjects. Higher white blood cell count was only associated with systemic infection when compared with our control group ( .018).
In patients diagnosed with CIED infections requiring extraction, inflammatory biomarkers were not elevated in isolated pocket infection. Inflammatory markers are not predictive of the diagnosis of pocket infections, which ultimately requires a high level of clinical suspicion.
心血管植入式电子设备（CIED）感染是设备取出的常见指征。早期诊断和完整的系统移除对于降低发病率和死亡率至关重要。缺乏明确的感染症状使得囊袋感染的诊断具有挑战性，可能会延迟取出设备的转诊。
我们旨在确定炎症生物标志物是否有助于诊断CIED孤立性囊袋感染。
我们对2012年至2022年在加利福尼亚大学圣地亚哥分校因CIED感染接受经静脉导线取出术的所有患者进行了回顾性分析（N = 156）。患者分为全身感染组（n = 88）或孤立性囊袋感染组（n = 68）。对前瞻性收集的术前降钙素原（PCT）、C反应蛋白和白细胞计数进行组间比较。
两两比较显示，全身感染组的PCT高于对照组（P <.001）和囊袋感染组（P <.009）。然而，对照组与孤立性囊袋感染组之间的PCT值无显著差异。与我们的对照组相比，白细胞计数升高仅与全身感染相关（P <.018）。
在被诊断为需要取出CIED感染的患者中，孤立性囊袋感染时炎症生物标志物并未升高。炎症标志物不能预测囊袋感染的诊断，最终需要高度的临床怀疑。
