Table 3.

Pooled effect estimates for potential risk factors predisposing to cardiac implantable electronic device infection

	Prospective + retrospective studies				Prospective studies only
Factor	Studies (n)	Total (n)	Pooled estimate	P-value	Studies (n)	Total (n)	Pooled estimate	P-value
Patient-related factors
ESRDa	8	3045	8.73 [3.42, 22.31]	0.00001	NA
History of device infection	4	463	7.84 [1.94, 31.60]	0.004	NA
Fever prior to implantation	3	6652	4.27 [1.13, 16.12]	0.03	2	6580	5.34 [1.002, 28.43]	0.05
Corticosteroid use	10	3432	3.44 [1.62, 7.32]	0.001	3	1349	2.10 [0.47, 9.32]	0.33
Renal insufficiencyb	5	2033	3.02 [1.38, 6.64]	0.006	NA
COPD	6	2810	2.95 [1.78, 4.90]	0.00003	2	2393	2.30 [0.97, 5.48]	0.06
NYHA class ≥ 2	3	2447	2.47 [1.24, 4.91]	0.01	2	2393	2.77 [1.26, 6.05]	0.01
Skin disorders	4	6810	2.46 [1.04, 5.80]	0.04	2	6519	2.60 [0.88, 7.70]	0.08
Malignancy	6	1555	2.23 [1.26, 3.95]	0.006	NA
Diabetes mellitus	18	11839	2.08 [1.62, 2.67]	<0.000001	7	9815	1.88 [1.19, 2.98]	0.007
Heparin bridging	2	6373	1.87 [1.03, 3.41]	0.04	NA
CHF	6	1277	1.65 [1.14, 2.39]	0.008	NA
Oral anticoagulants	9	8527	1.59 [1.01, 2.48]	0.04	3	7271	1.18 [0.44, 3.11]	0.75
Procedure-related factors
Procedure duration	9	4850	9.89 [0.52, 19.25]	0.04	6	4508	13.04 [-0.64, 26.73]	0.06
Haematoma	12	14228	8.46 [4.01, 17.86]	<0.000001	6	9715	9.33 [2.84, 30.69]	0.0002
Lead repositioning	5	1755	6.37 [2.93, 13.82]	0.000003	4	1659	7.03 [2.49, 19.85]	0.0002
Inexperienced operatorc	2	1715	2.85 [1.23, 6.58]	0.01	2	1715	2.85 [1.23, 6.58]	0.01
Temporary pacing	10	10683	2.31 [1.36, 3.92]	0.002	4	8683	3.29 [1.87, 5.80]	0.00004
Device replacement/revision/upgrade	26	21214	1.98 [1.46, 2.70]	0.00001	8	8793	0.95 [0.49, 1.87]	0.89
Generator change	20	12134	1.74 [1.22, 2.49]	0.002	6	2139	0.91 [0.37, 2.22]	0.83
Antibiotic prophylaxis	16	14166	0.32 [0.18, 0.55]d	0.00005	11	10864	0.29 [0.13, 0.63]	0.002
Device-related factors
Epicardial leads	3	623	8.09 [3.46, 18.92]	0.000001	NA
Abdominal pocket	7	4017	4.01 [2.48, 6.49]	<0.000001	2	2268	5.03 [1.96, 12.91]	0.0008
≥2 leads	6	1146	2.02 [1.11, 3.69]	0.02	NA
Dual-chamber device	14	45224	1.45 [1.02, 2.05]	0.04	7	12102	1.28 [0.73, 2.25]	0.38

Risk parameters which were statistically significant for retrospective and prospective data are shown. Analyses restricted to prospective data only for the same parameters (if available) are also shown. Adapted from Polyzos et al.²¹

CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; ESRD, end-stage renal disease; NA, not available; NYHA, New York Heart Association.

^aGFR ≤15  mL/min or haemodialysis or peritoneal dialysis.

^bGlomerular filtration rate (GFR) <60 mL/min or creatinine clearance (CrCL) <60  mL/min.

^c<100 previous procedures.

^dThe pooled effect estimate from randomized studies was 0.26 [0.13, 0.52].