Arrhythmias & electrophysiology
The BLISTER Score: A Novel, Externally Validated Tool for Predicting Cardiac Implantable Electronic Device Infections, and Its Cost-Utility Implications for Antimicrobial Envelope Use
Authors' conclusion
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.
Study context
- Population
- Patients undergoing cardiac implantable electronic device procedures, UKderivation n=7383
- Participants
- 12,198 patients
- Comparison
- BLISTER score vs PADIT score
- Outcome
- Cardiac implantable electronic device infection (discriminative performance, AUC)
- Follow-up
- 12 months after procedure
Methodological detailsexternal validation cohorts, cost-utility modelling
- External validation cohorts
- Cost-utility modelling
Performance
As reported in the abstract
Discrimination for CIED infection (AUC)
| Test or model | AUC, standard-risk cohort | AUC, high-risk cohort | AUC, all patients |
|---|---|---|---|
| BLISTER | 0.82 | 0.77 | 0.8 |
| PADIT | 0.71 | 0.69 | 0.75 |
AUC, standard-risk cohort
BLISTER0.82
PADIT0.71
AUC, high-risk cohort
BLISTER0.77
PADIT0.69
AUC, all patients
BLISTER0.8
PADIT0.75
- BLISTER vs PADIT: P = 0.001 — standard-risk cohort (n=2854, event rate 0.8%)
- BLISTER vs PADIT: P = 0.001 — high-risk cohort (n=1961, event rate 2.0%)
- BLISTER vs PADIT: P = 0.002 — all patients (n=12 198, event rate 1%)
Further findings
Independent predictors of CIED infection beyond PADIT constituents (derivation cohort, n=7383) · within 12 months of a procedure
- Lead extraction: HR 3.3 (95% CI 1.9-6.1)
- P < 0.0001
- C-reactive protein >50 mg/L: HR 3.0 (95% CI 1.4-6.4)
- P = 0.005
- Reintervention within 2 years: HR 10.1 (95% CI 5.6-17.9)
- P < 0.0001
- Top-quartile procedure duration: HR 2.6 (95% CI 1.6-4.1)
- P = 0.001
- 59 infections (event rate 0.8%)
Decision-analytic modelling: antimicrobial envelopes assigned to patients with BLISTER scores ≥6 (10.8%), the optimum scenario
- Relative risk reduction in infections
- 30%
- Incremental cost-effectiveness ratio, within NICE cost-utility thresholds
- £18 446
- P=0.036
Original publication
The BLISTER Score: A Novel, Externally Validated Tool for Predicting Cardiac Implantable Electronic Device Infections, and Its Cost-Utility Implications for Antimicrobial Envelope Use. Circ Arrhythm Electrophysiol. Published 22 January 2024. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →