Abstract 14358: Bacteremia in Continuous-Flow Left Ventricular Assist Device and Increased Risk for Intracranial Hemorrhage: Insights From National Inpatient Sample Database

Abstract

Introduction: Implantable continuous-flow left ventricular assist devices (LVADs) are used in patients with end-stage heart failure as a bridge to transplant or as a destination therapy. In order to prevent pump malfunction as well as strokes, long term warfarin therapy is prescribed which puts them at risk of bleeding at the same time. Small retrospective studies have suggested the relationship between bloodstream infections and increased risk for intracranial hemorrhages (ICH). Hypothesis: Accordingly, we sought to test the hypothesis that “bacteremia is associated with increased ICH risk in LVAD dependent patients” in a large national database. Methods: National Inpatient Sample (NIS) database was queried to identify LVAD patients admitted between 2011-2018, using Internal Classification of Diseases 9th and 10th Revision Clinical Modification procedure codes. Outcomes of interest were bacteremia and ICH. A logistic regression model was used for the statistical analysis while adjusting for potential confounders using Elixhauser index score. Results: Between 2011-2018, a total of 120,050 (median age 58 yrs, 23.4% female) LVAD dependent patients were admitted to hospitals across the United States. Bacteremia was encountered in 4.3 % of patients. A total of 2.4% of patients developed hemorrhagic stroke during the same hospitalization. Presence of bacteremia (vs. no bacteremia) was associated with 2.3-fold increased risk of ICH (Odds ratio [95% CI] =2.38 [1.79, 3.17], p<0.0001. Fig A ) after adjustment for age, sex, race, and Elixhauser index score. The yearly incidence trends of bacteriemia and ICH in LVAD dependent patients are shown in Fig B . Conclusions: In LVAD dependent patients, presence of bacteremia is associated with significantly increased risk of ICH. Since these patients are on warfarin, further studies are needed to evaluate if lowering the goal prothrombin time (PT), while septic, would alleviate this increased risk of ICH in such population.