BACKGROUND

Ventricular assist device (VAD) patients often experience infections, which increase the risk of stroke and mortality. Using the definitions of the International Society for Heart and Lung Transplantation (ISHLT), we have characterized differences in clinical outcomes for categories of infection: VAD-specific (e.g., pump component related); VAD-related (e.g., bloodstream infection, BSI); and non-VAD infections (e.g., pneumonia).

METHODS

Querying of the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) identified 16,597 continuous-flow VAD recipients. Categories of infection were tested in multivariate models to determine the risk of stroke and death.

RESULTS

After implant, 7,046 patients (42%) developed an infection at a median of 69 (interquartile range 12 to 272) days. A majority were non-VAD infections (49%), followed by VAD-related (26%) and VAD-specific infections (25%). BSIs were the most common form of VAD-related infection (92%), and the majority (59%) had no associated infection, that is, idiopathic bacteremia. Internal pump component infections were rare (0.003 event per patient-year [EPPY]). Infected VAD patients had a higher prevalence of stroke compared to patients without an infection (18% vs 11%, p < 0.001). The lowest stroke rate occurred after a VAD-specific infection (0.11 EPPY) compared with VAD-related (0.17 EPPY) and non-VAD infections (0.15 EPPY, p < 0.001). Hemorrhagic strokes were more common than ischemic strokes in all infection groups and highest after a VAD-related infection (0.13 EPPY). One-year survival after an infection was 87% in VAD-specific infections, as compared with VAD-related (71%) and non-VAD infections (72%, p < 0.001).

CONCLUSIONS

The ISHLT categorization of VAD infections unveils notable differences in associated risk of stroke and mortality. A re-assessment of transplant prioritization for eligible infected VAD patients may be useful to increase transplant-related survival benefit.

中文翻译：

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心室辅助设备患者的中风和死亡风险因ISHLT感染类别而异：INTERMACS分析。

背景

心室辅助设备（VAD）患者经常会发生感染，这会增加中风和死亡的风险。使用国际心脏和肺移植协会（ISHLT）的定义，我们对感染类别的临床结果差异进行了特征描述：VAD特异性（例如，与泵组件有关）；与VAD相关（例如，血液感染，BSI）；非VAD感染（例如肺炎）。

方法

在机构间注册中心的机械辅助循环支持（INTERMACS）查询中，确定了16,597个连续流VAD接收者。在多变量模型中测试了感染类别，以确定中风和死亡的风险。

结果

植入后，有7,046名患者（42％）在中位69天（四分位间距为12至272）天出现了感染。大多数是非VAD感染（49％），其次是VAD相关（26％）和VAD特异性感染（25％）。BSI是最常见的VAD相关感染形式（92％），而大多数（59％）没有相关感染，即特发性菌血症。内部泵组件感染很少（每患者年0.003事件[EPPY]）。与未感染的患者相比，被感染的VAD患者的中风患病率更高（18％比11％，p <0.001）。与VAD相关感染（0.17 EPPY）和非VAD相关感染（0.15 EPPY，p<0.001）。在所有感染组中，出血性中风比缺血性中风更为常见，在发生VAD相关感染后出血性中风最高（0.13 EPPY）。与VAD相关的感染（71％）和非VAD感染（72％，p <0.001）相比，VAD特异性感染在感染后的一年生存率为87％。

结论

ISHLT对VAD感染的分类揭示了中风和死亡相关风险的显着差异。对合格的受感染的VAD患者重新评估移植优先顺序可能有助于增加与移植相关的生存获益。