title: Predictors of mortality in patients with cardiovascular implantable electronic device infections.
abstract: Infection reduces survival in cardiovascular implantable electronic device (CIED) recipients. However, the clinical predictors of short- and long-term mortality in patients with CIED infection are not well understood. We retrospectively reviewed all patients with CIED infection who were admitted to Mayo Clinic from January 1991 to December 2008. Survival data were obtained from the medical records and the United Sates Social Security Index. The purported risk factors for short-term (30-day) and long-term (>30-day) mortality were analyzed using univariate and multivariate models. Overall, 415 cases of CIED infection were identified during the study period. The mean follow-up duration for the 243 patients who were alive at the last follow-up visit was 6.9 years. In a multivariate model, heart failure (odds ratio 9.31, 95% confidence interval 2.08 to 41.67), corticosteroid therapy (odds ratio 4.04, 95% confidence interval 1.40 to 11.60), and presentation with CIED-related infective endocarditis (odds ratio 5.60, 95% confidence interval 2.25 to 13.92) were associated with increased short-term mortality. The factors associated with long-term mortality in the multivariate model included patient age (hazard ratio 1.20, 95% confidence interval 1.06 to 1.36), heart failure (hazard ratio 2.01, 95% confidence interval 1.42 to 2.86), metastatic malignancy (hazard ratio 5.99, 95% confidence interval 1.67 to 21.53), corticosteroid therapy (hazard ratio 1.97, 95% confidence interval 1.22 to 3.18), renal failure (hazard ratio 1.94, 95% confidence interval 1.37 to 2.74), and CIED-related infective endocarditis (hazard ratio 1.68, 95% confidence interval 1.17 to 2.41). In conclusion, these data suggest that the development of CIED-related infective endocarditis and the presence of co-morbid conditions are associated with increased short- and long-term mortality in patients with CIED infection.
authors.affiliation: Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, MN, USA.
authors.forename: Ammar
authors.initials: A
authors.lastname: Habib
authors.forename: Katherine Y
authors.initials: KY
authors.lastname: Le
authors.forename: Larry M
authors.initials: LM
authors.lastname: Baddour
authors.forename: Paul A
authors.initials: PA
authors.lastname: Friedman
authors.forename: David L
authors.initials: DL
authors.lastname: Hayes
authors.forename: Christine M
authors.initials: CM
authors.lastname: Lohse
authors.forename: Walter R
authors.initials: WR
authors.lastname: Wilson
authors.forename: James M
authors.initials: JM
authors.lastname: Steckelberg
authors.forename: M Rizwan
authors.initials: MR
authors.lastname: Sohail
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015897:Comorbidity; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D004696:Endocarditis / Q000382:microbiology / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D016016:Proportional Hazards Models; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate