Impact of sepsis on morbidity and mortality in patients with cardiac implantable electronic devices: real-world data from a high-volume center

Background

Patients with cardiac implantable electronic devices (CIEDs) are at risk of device-related infections, which are associated with increased mortality. In cases of infective endocarditis or recurrent occult bacteremia, complete device and lead removal by transvenous lead extraction (TLE) is indicated. This study aimed to investigate the impact of CIED presence on in-hospital mortality in patients with sepsis.

Methods

This analysis included patients hospitalized at our center between August 2016 and January 2025 with a diagnosis of sepsis or infective endocarditis. Diagnoses were defined based on diagnosis-related group (DRG) documentation in administrative data. The primary endpoint was in-hospital mortality. The association between CIED presence and mortality was assessed using adjusted and matched logistic regression models.

Results

A total of 3,544 cases of sepsis and infective endocarditis were analyzed (sepsis n=3,092; endocarditis n=452). In the overall cohort, patients with CIEDs more frequently had renal disease and heart disease (70% vs. 55% and 43% vs. 31%, respectively). In the extended multivariable logistic regression model, increasing age was significantly associated with higher mortality (OR 1.89 per 20 years, 95% CI 1.66–2.16; p<0.001). Female sex was associated with slightly higher mortality compared with male sex (OR 1.23; 95% CI 1.04–1.45; p=0.014). Dialysis dependency (OR 4.43; 95% CI 3.57–5.49; p<0.001) and renal insufficiency (OR 1.38; 95% CI 1.16–1.55; p<0.001) were also strong predictors of mortality. CIED presence was not significantly associated with mortality in the overall cohort (p=0.308). However, after matching for age, sex, comorbidities, and procedures, an age-dependent association between CIED presence and mortality was observed.

In the extended logistic regression model restricted to CIED patients, increasing age (p<0.001), female sex (p=0.044), dialysis dependency (p<0.001), malignancy (p<0.001), and cerebrovascular disease (p<0.001) were independent predictors of mortality. TLE showed no significant effect in the overall CIED cohort; however, in age-specific analysis at the median age of 70 years, TLE was associated with significantly lower mortality (OR 0.64; 95% CI 0.41–0.99; p=0.023). Overall, TLE was performed in only 7.3% of CIED patients (3.2% [n=22/679] in sepsis and 28% [n=38/135] in infective endocarditis).

Conclusion

In patients with sepsis, the presence of a CIED was not associated with increased in-hospital mortality in the overall cohort. Increasing age, dialysis dependency, malignancy, and cerebrovascular comorbidities were independent predictors of mortality. TLE was performed infrequently and varied between departments, without demonstrating a generalized survival benefit. Further analyses may help to better target therapeutic strategies in the future.