终末期肾病患者心血管植入式电子设备感染的发生率和结果。

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm Pub Date : 2025-03-01 DOI:10.1016/j.hrthm.2024.09.016

Sania Jiwani MBBS , Wan-Chi Chan MBBS , Akshaya Gadre MBBS , Seth Sheldon MD, FHRS , Jinxiang Hu PhD , Rhea Pimentel MD, FHRS , Amit Noheria MBBS, SM , Kamal Gupta MBBS

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引用次数: 0

摘要

背景：终末期肾病（ESKD）患者容易发生血流感染，这可能导致心脏植入式电子装置（CIED）感染的风险更高：目的：评估接受心脏植入式电子设备（CIED）再次植入手术的ESKD患者CIED感染的发生率、风险预测因素、管理策略和长期结果：这是一项利用美国肾脏数据系统进行的回顾性研究。研究纳入了 2006 年 1 月 1 日至 2014 年 9 月 30 日期间接受去原位 CIED 植入术的 ESKD 患者。对患者进行随访，直至死亡、肾移植、医疗保险结束或2015年9月30日，以评估CIED感染的发生率。根据 CIED 感染确诊后 60 天内的引线拔除手术代码确定管理方法。随访CIED感染患者至2019年12月31日，以评估长期结果：结果：在15,515名接受重新植入CIED的ESKD患者中，CIED感染发生率为4.8%，中位随访时间为1.3年。使用除颤器（aHR 1.48）、体重指数较高（aHR 1.01）、年龄较小（aHR 0.96）是CIED感染的独立风险因素。只有50.71%的患者在60天前拔出了导线。经过倾向评分匹配后，未进行拔管的患者的3年死亡率高于进行拔管的患者（80.3%对72.3%），且死亡时间更短（0.3年对0.6年）。只有13.8%的患者在拔除导联后重新植入了新的CIED：结论：CIED感染经常发生在ESKD患者中，死亡率非常高。结论：CIED感染经常发生在ESKD患者身上，死亡率非常高。早期拔除导联并不是常规做法，但却能提高存活率。

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Incidence and outcomes of cardiovascular implantable electronic device infections in patients with end-stage kidney disease

Background

End-stage kidney disease (ESKD) patients are prone to bloodstream infections that may result in a higher risk of cardiac implantable electronic device (CIED) infections.

Objective

The objective of this study was to assess the incidence, risk predictors, management strategies, and long-term outcomes of CIED infections in ESKD patients undergoing de novo CIED implantation.

Methods

This is a retrospective study using the United States Renal Data System. ESKD patients with de novo CIED implantation between January 1, 2006, and September 30, 2014, were included. Patients were observed until death, kidney transplantation, end of Medicare coverage, or September 30, 2015, to assess incidence of CIED infection. Management approach was determined from procedure codes for lead extraction within 60 days of CIED infection diagnosis. Patients with CIED infection were observed until December 31, 2019, to assess long-term outcomes.

Results

Of 15,515 ESKD patients undergoing de novo CIED implantation, incidence of CIED infection was 4.8% during a median follow-up of 1.3 years. The presence of a defibrillator (adjusted hazard ratio [aHR], 1.48), higher body mass index (aHR, 1.01), and younger age (aHR, 0.96) were independent risk factors for CIED infection. Lead extraction occurred in only 50.71% of patients by 60 days. After propensity score matching, the 3-year mortality was higher in those who did not undergo lead extraction compared with those who did (80.3% vs 72.3%) and time to mortality was shorter (0.3 vs 0.6 year). Only 13.8% of patients underwent reimplantation with a new CIED after lead extraction.

Conclusion

CIED infections occur frequently in ESKD patients and are associated with a high mortality. Early lead extraction is not performed routinely but is associated with improved survival.

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来源期刊

Heart rhythm 医学-心血管系统

CiteScore

10.50

自引率

5.50%

发文量

1465

审稿时长

24 days

期刊介绍： HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability. HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community. The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.