Risk factors for mortality in patients with cardiac device-related infection.
BACKGROUND
Because of the increased use of pacemakers and implantable cardioverter defibrillators, infection has become a complication with significant morbidity and mortality. Data on risk factors for mortality in patients with cardiac-device related infection are limited. We evaluated the prognostic significance of key clinical and echocardiographic variables in a large retrospective population of patients with cardiac-device related infection.


RESULTS
Two hundred ten patients with cardiac-device related infection were identified at the University of Michigan between 1995 and 2006. Data were abstracted on key clinical and echocardiographic variables, treatment strategy, and 6-month outcomes. We used multivariable Cox proportional hazards models to examine clinical and echocardiographic variables that were associated with 6-month mortality. Mean age for our study population was 63+/-17 years, and 72 (44%) were women. All-cause 6-month mortality was 18% (n=37). Independent variables associated with death were systemic embolization (hazard ratio 7.11; 95% CI 2.74 to 18.48), moderate or severe tricuspid regurgitation (hazard ratio 4.24; 95% CI 1.84 to 9.75), abnormal right ventricular function (hazard ratio 3.59; 95% CI 1.57 to 8.24), and abnormal renal function (hazard ratio 2.98; 95% CI 1.17 to 7.59). Size and mobility of cardiac device vegetations were not independently associated with mortality.


CONCLUSIONS
We identified several clinical and echocardiographic variables that identify patients with cardiac-device related infection who are at high-risk for mortality and may benefit from more aggressive evaluation.
Baman
Timir S
TS
Department of Cardiology, University of Michigan, Ann Arbor, Michigan, USA.
Gupta
Sanjaya K
SK
Valle
Javier A
JA
Yamada
Elina
E
D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000401:mortality* / Q000628:therapy; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008824:Michigan / Q000453:epidemiology; D009017:Morbidity; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D011379:Prognosis; D016016:Proportional Hazards Models; D016459:Prosthesis-Related Infections / Q000401:mortality*; D011655:Pulmonary Embolism / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors