PDF(Pubmed)
Abstract：
OBJECTIVE: Cardiac implantable electronic device (CIED) infections are a burden to hospitals and costly for healthcare systems. Chronic kidney disease (CKD) increases the risk of CIED infections, but its differential impact on healthcare utilization, costs, and outcomes is not known.
RESULTS: This retrospective analysis used de-identified Medicare Fee-for-Service claims to identify patients implanted with a CIED from July 2016 to December 2020. Outcomes were defined as hospital days and costs within 12 months post-implant, post-infection CKD progression, and mortality. Generalized linear models were used to calculate results by CKD and infection status while controlling for other comorbidities, with differences between cohorts representing the incremental effect associated with CKD. A total of 584 543 patients had a CIED implant, of which 26% had CKD and 1.4% had a device infection. The average total days in hospital for infected patients was 23.5 days with CKD vs. 14.5 days (P < 0.001) without. The average cost of infection was $121 756 with CKD vs. $55 366 without (P < 0.001), leading to an incremental cost associated with CKD of $66 390. Infected patients with CKD were more likely to have septicaemia or severe sepsis than those without CKD (11.0 vs. 4.6%, P < 0.001). After infection, CKD patients were more likely to experience CKD progression (hazard ratio 1.26, P < 0.001) and mortality (hazard ratio 1.89, P < 0.001).
CONCLUSIONS: Cardiac implantable electronic device infection in patients with CKD was associated with more healthcare utilization, higher cost, greater disease progression, and greater mortality compared to patients without CKD.
RESULTS: This retrospective analysis used de-identified Medicare Fee-for-Service claims to identify patients implanted with a CIED from July 2016 to December 2020. Outcomes were defined as hospital days and costs within 12 months post-implant, post-infection CKD progression, and mortality. Generalized linear models were used to calculate results by CKD and infection status while controlling for other comorbidities, with differences between cohorts representing the incremental effect associated with CKD. A total of 584 543 patients had a CIED implant, of which 26% had CKD and 1.4% had a device infection. The average total days in hospital for infected patients was 23.5 days with CKD vs. 14.5 days (P < 0.001) without. The average cost of infection was $121 756 with CKD vs. $55 366 without (P < 0.001), leading to an incremental cost associated with CKD of $66 390. Infected patients with CKD were more likely to have septicaemia or severe sepsis than those without CKD (11.0 vs. 4.6%, P < 0.001). After infection, CKD patients were more likely to experience CKD progression (hazard ratio 1.26, P < 0.001) and mortality (hazard ratio 1.89, P < 0.001).
CONCLUSIONS: Cardiac implantable electronic device infection in patients with CKD was associated with more healthcare utilization, higher cost, greater disease progression, and greater mortality compared to patients without CKD.
摘要：
目的：心脏可植入电子设备（CIED）感染是医院的负担，对医疗保健系统而言成本高昂。慢性肾脏病（CKD）增加CIED感染的风险，但它对医疗保健利用的不同影响，成本,结果未知。
方法：这项回顾性分析使用了从2016年7月至2020年12月取消识别的Medicare服务费（FFS）索赔来识别植入aCIED的患者。结果定义为植入后12个月内的住院天数和费用，感染后CKD进展和死亡率。在控制其他合并症的同时，使用广义线性模型来计算CKD和感染状态的结果。队列之间的差异代表了与CKD相关的增量效应。
结果：共有584,543名患者进行了aCIED植入，其中26%患有CKD,1.4%患有器械感染.感染CKD患者的平均住院天数为23.5天，而非CKD患者为14.5天（p<.001）。CKD的平均感染成本为$121,756，而非CKD的平均感染成本为$55,366（p<0.001），导致与CKD相关的增量成本为66,390美元。与没有CKD的患者相比，感染CKD的患者更容易发生败血症或严重败血症（11.0％vs4.6％，p<.001)。感染后,CKD患者更有可能出现CKD进展（HR1.26，p<.001）和死亡率（HR1.89，p<.001）。
结论：CKD患者的CIED感染与更多的医疗保健利用相关，更高的成本，更大的疾病进展，与无CKD患者相比，死亡率更高。
方法：这项回顾性分析使用了从2016年7月至2020年12月取消识别的Medicare服务费（FFS）索赔来识别植入aCIED的患者。结果定义为植入后12个月内的住院天数和费用，感染后CKD进展和死亡率。在控制其他合并症的同时，使用广义线性模型来计算CKD和感染状态的结果。队列之间的差异代表了与CKD相关的增量效应。
结果：共有584,543名患者进行了aCIED植入，其中26%患有CKD,1.4%患有器械感染.感染CKD患者的平均住院天数为23.5天，而非CKD患者为14.5天（p<.001）。CKD的平均感染成本为$121,756，而非CKD的平均感染成本为$55,366（p<0.001），导致与CKD相关的增量成本为66,390美元。与没有CKD的患者相比，感染CKD的患者更容易发生败血症或严重败血症（11.0％vs4.6％，p<.001)。感染后,CKD患者更有可能出现CKD进展（HR1.26，p<.001）和死亡率（HR1.89，p<.001）。
结论：CKD患者的CIED感染与更多的医疗保健利用相关，更高的成本，更大的疾病进展，与无CKD患者相比，死亡率更高。
