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Inflammatory biomarkers as predictors of systemic vs isolated pocket infection in patients undergoing transvenous
Anne-Sophie Lacharite-Roberge1, Sandeep Toomu1, Omar Aldaas1
1Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Diego, San Diego, California.
Insights
Inflammatory biomarkers like procalcitonin do not reliably detect cardiovascular implantable electronic device (CIED) pocket infections. Clinical suspicion remains key for diagnosing these challenging CIED infections.
Area of Science:
- Cardiology
- Infectious Diseases
- Biomarkers
Background:
- Cardiovascular implantable electronic device (CIED) infections are a frequent reason for device extraction.
- Diagnosing CIED pocket infections is difficult due to subtle symptoms, potentially delaying necessary extraction.
- Early detection and complete device removal are vital for patient outcomes.
Purpose of the Study:
- To investigate the utility of inflammatory biomarkers in diagnosing isolated CIED pocket infections.
- To assess if biomarkers can differentiate pocket infections from systemic infections or absence of infection.
Main Methods:
- Retrospective analysis of 156 patients undergoing transvenous lead extraction for CIED infection.
- Classification of patients into systemic infection (n=88) or isolated pocket infection (n=68) groups.
- Comparison of preoperative procalcitonin (PCT), C-reactive protein, and white blood cell count between groups and controls.
Main Results:
- Procalcitonin (PCT) was significantly higher in systemic infection compared to controls and pocket infection groups.
- No significant difference in PCT was observed between isolated pocket infection and control groups.
- Elevated white blood cell count was associated only with systemic infection, not pocket infection.
Conclusions:
- Inflammatory biomarkers are not elevated in isolated CIED pocket infections requiring extraction.
- Current inflammatory markers are not predictive for diagnosing CIED pocket infections.
- Diagnosis of CIED pocket infections relies heavily on clinical suspicion.
Background:
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.
Objective:
We aimed to determine if inflammatory biomarkers can help diagnose CIED isolated pocket infection.
Methods:
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.
Results:
Pairwise comparisons revealed that the systemic infection group had a higher PCT than the control group (P < .001) and the pocket infection group (P = .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 (P = .018).
Conclusion:
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.
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