BACKGROUND:Antimicrobial envelopes reduce the incidence of cardiac implantable electronic device infections, but their cost restricts routine use in the United Kingdom. Risk scoring could help to identify which patients would most benefit from this technology.METHODS:A novel risk score (BLISTER [Blood results, Long procedure time, Immunosuppressed, Sixty years old (or younger), Type of procedure, Early re-intervention, Repeat procedure]) was derived from multivariate analysis of factors associated with cardiac implantable electronic device infection. Diagnostic utility was assessed against the existing PADIT score (Prior procedure, Age, Depressed renal function, Immunocompromised, Type of procedure) in both standard and high-risk external validation cohorts, and cost-utility models examined different BLISTER and PADIT score thresholds for TYRX (Medtronic; Minneapolis, MN) antimicrobial envelope allocation.RESULTS:In a derivation cohort (n=7383), cardiac implantable electronic device infection occurred in 59 individuals within 12 months of a procedure (event rate, 0.8%). In addition to the PADIT score constituents, lead extraction (hazard ratio, 3.3 [95% CI, 1.9–6.1]; P<0.0001), C-reactive protein >50 mg/L (hazard ratio, 3.0 [95% CI, 1.4–6.4]; P=0.005), reintervention within 2 years (hazard ratio, 10.1 [95% CI, 5.6–17.9]; P<0.0001), and top-quartile procedure duration (hazard ratio, 2.6 [95% CI, 1.6–4.1]; P=0.001) were independent predictors of infection. The BLISTER score demonstrated superior discriminative performance versus PADIT in the standard risk (n=2854, event rate: 0.8%, area under the curve, 0.82 versus 0.71; P=0.001) and high-risk validation cohorts (n=1961, event rate: 2.0%, area under the curve, 0.77 versus 0.69; P=0.001), and in all patients (n=12 198, event rate: 1%, area under the curve, 0.8 versus 0.75, P=0.002). In decision-analytic modeling, the optimum scenario assigned antimicrobial envelopes to patients with BLISTER scores ≥6 (10.8%), delivering a significant reduction in infections (relative risk reduction, 30%; P=0.036) within the National Institute for Health and Care Excellence cost-utility thresholds (incremental cost-effectiveness ratio, £18 446).CONCLUSIONS:The BLISTER score (https://qxmd.com/calculate/calculator_876/the-blister-score-for-cied-infection) was a valid predictor of cardiac implantable electronic device infection, and could facilitate cost-effective antimicrobial envelope allocation to high-risk patients.

中文翻译：

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BLISTER 评分：一种新颖的、经过外部验证的工具，用于预测心脏植入式电子设备感染及其对抗菌包膜使用的成本效用影响

背景：抗菌包膜可降低心脏植入电子设备感染的发生率，但其成本限制了在英国的常规使用。风险评分可以帮助确定哪些患者最能从这项技术中受益。 方法：新的风险评分（BLISTER [血液结果、手术时间长、免疫抑制、六十岁（或以下）、手术类型、早期再干预、重复程序]）源自与心脏植入式电子设备感染相关因素的多变量分析。在标准和高风险外部验证队列中根据现有 PADIT 评分（既往手术、年龄、肾功能低下、免疫功能低下、手术类型）评估诊断效用，成本效用模型检查 TYRX 的不同 BLISTER 和 PADIT 评分阈值（美敦力；明尼苏达州明尼阿波利斯）抗菌包膜分配。结果：在衍生队列 (n=7383) 中，手术后 12 个月内有 59 名个体发生心脏植入式电子设备感染（事件发生率为 0.8%）。除 PADIT 评分成分外，还包括铅提取（风险比，3.3 [95% CI，1.9–6.1]；P <0.0001）、C 反应蛋白 >50 mg/L（风险比，3.0 [95% CI，1.4] –6.4]；P = 0.005），2 年内再次干预（风险比，10.1 [95% CI，5.6–17.9]；P <0.0001），以及前四分位手术持续时间（风险比，2.6 [95% CI，1.6] –4.1]；P = 0.001）是感染的独立预测因子。在标准风险（n=2854，事件发生率：0.8%，曲线下面积，0.82 与 0.71；P =0.001）和高风险验证队列（n=1961，事件发生率）中，BLISTER 评分表现出优于 PADIT 的区分性能：2.0%，曲线下面积，0.77 对比 0.69；P = 0.001），并且在所有患者中（n = 12 198，事件发生率：1%，曲线下面积，0.8 对比 0.75，P = 0.002）。在决策分析模型中，最佳方案将抗菌包膜分配给 BLISTER 评分 ≥6 的患者 (10.8%)，从而显着减少国家健康与护理研究所内的感染率（相对风险降低 30%； P =0.036）卓越成本效用阈值（增量成本效益比，18 446 英镑）。结论：BLISTER 评分 (https://qxmd.com/calculate/calculator_876/the-blister-score-for-cied-infection) 是有效的心脏植入电子设备感染的预测因子，并且可以促进向高危患者分配具有成本效益的抗菌包膜。