Validation of the PADIT risk score for predicting cardiac device-related pocket and systemic infections
M Golian, N Berbenetz, N Berbenetz, M Sadek, M Sadek, F Ramirez, F Ramirez, P Nery, P Nery, G Nair, G Nair, D Davis, D Davis, C Redpath, C Redpath, A Klein, A Klein, A Aydin, A Aydin, V Corrales-Medina, V Corrales-Medina, S Hansom, S Hansom, M Green, M Green, D Birnie, D BirnieAbstract
Background
Cardiac implantable electronic device (CIED) infections remain a major cause of morbidity, mortality, and healthcare burden. The PADIT risk score has been proposed to identify patients at elevated risk, enabling targeted infection-prevention strategies. Recent studies have further differentiated between pocket and systemic infection subtypes, suggesting distinct clinical risk profiles. However, these subtypes remain insufficiently characterized in current risk prediction models.
Objective
(i) Validate the PADIT risk score in a large cohort.
(ii) Identify and compare risk factors for pocket versus systemic infections.
(iii) Evaluate PADIT score performance across infection subtypes.
Methods
A prospective registry of all CIED implant procedures was started at our institution in January 2007. The registry was initiated in collaboration with our hospital infection prevention team with a specific focus on prospectively identifying all potential CIED infections PADIT risk score components were identified for each procedure. All potential CIED infections were independently adjudicated by two physicians (with a third as needed), blinded to PADIT score and all other pre-operative variables. Also, all adjudicated infections were subclassified into pocket infection alone or systemic infection.
Results
Among 14,225 patients undergoing CIED procedures, 103 (0.7%) developed infections. These patients were younger (66.0 ± 15.0 vs. 72.2 ± 13.8 years, p<0.01), more likely to receive ICD or CRT devices, and had ≥2 prior procedures (21.4% vs. 8.8%, p<0.01). The PADIT risk score showed a moderate discrimination for overall CIED infection (c-statistic 0.690, AIC 1178.3) with excellent calibration (ratio 1.000). Subgroup analyses showed similar performance for pocket infections (c-statistic 0.691) and higher discrimination for systemic infections (c-statistic 0.730). In multivariable models, age <60 years (OR 2.13, 95% CI 1.28–3.48), ICD (OR 1.76, p=0.036), CRT (OR 2.48, p=0.002), and ≥2 prior procedures (OR 2.42, p<0.001) independently predicted adjudicated infection.
Conclusion
Independent validation confirmed that the PADIT score reliably predicts CIED infection risk, performing consistently across subtypes and showing highest discriminatory power for systemic infections.