Biomarker-based diagnosis of pacemaker and implantable cardioverter defibrillator pocket infections: A prospective, multicentre, case-control evaluationReport as inadecuate




Biomarker-based diagnosis of pacemaker and implantable cardioverter defibrillator pocket infections: A prospective, multicentre, case-control evaluation - Download this document for free, or read online. Document in PDF available to download.

Background

The use of cardiac implantable electronic devices CIED has risen steadily, yet the rate of cardiac device infections CDI has disproportionately increased. Amongst all cardiac device infections, the pocket infection is the most challenging diagnosis. Therefore, we aimed to improve diagnosis of such pocket infection by identifying relevant biomarkers.

Methods

We enrolled 25 consecutive patients with invasively and microbiologically confirmed pocket infection. None of the patients had any confounding conditions. Pre-operative levels of 14 biomarkers were compared in infected and control n = 50 patients. Our selected biomarkers included white blood cell count WBC, C-reactive protein CRP, procalcitonin PCT, lipopolysaccharide binding protein, high-sensitivity C-reactive protein HS-CRP, polymorphonuclear-elastase, presepsin, various interleukins, tumor necrosis factor α TNF-α, and granulocyte macrophage colony-stimulating factor GM-CSF.

Results

Of the 25 patients with isolated pocket infection 70±13years, 76% male, 40% ICDs, none presented with leukocytosis. In contrast, they had higher serum levels of HS-CRP p = 0.019 and PCT p = 0.010 than control patients. Median PCT-level was 0.06 ng-mL IQR 0.03–0.07 ng-mL in the study group versus 0.03 ng-mL IQR 0.02–0.04 ng-mL in controls. An optimized PCT cut-off value of 0.05 ng-mL suggests pocket infection with a sensitivity of 60% and specificity of 82%. In addition TNF-α- and GM-CSF-levels were lower in the study group. Other biomarkers did not differ between groups.

Conclusion

Diagnosis of isolated pocket infections requires clinical awareness, physical examination, evaluation of blood cultures and echocardiography assessment. Nevertheless, measurement of PCT- and HS-CRP-levels can aid diagnosis. However, no conclusion can be drawn from normal WBC-values.

Clinical trial registration

clinicaltrials.gov identifier: NCT01619267



Author: Carsten Lennerz , Hrvoje Vrazic, Bernhard Haller, Siegmund Braun, Tobias Petzold, Ilka Ott, Agnes Lennerz, Jonathan Michel, Patri

Source: http://plos.srce.hr/



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