{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T19:05:54Z","timestamp":1790363154117,"version":"4.1.0"},"reference-count":33,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2023,12,4]],"date-time":"2023-12-04T00:00:00Z","timestamp":1701648000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Patients with infectious complications related to the presence of cardiac implantable electronic devices (CIED) constitute a heterogeneous group, ranging from local pocket infection (PI) to lead-related infectious endocarditis (LRIE) infection spreading along the leads to the endocardium. The detection of isolated LRIE and the assessment of the spread of infection in a patient with PI is often difficult and requires complex imaging and microbiological tests. The aim of the current study is to evaluate the usefulness of new simple hematological parameters in detecting infectious complications in patients with CIED, differentiating vegetation and vegetation-like masses, and assessing the extent of infections in patients with PI. Methods: A retrospective analysis of clinical data of 2909 patients (36.37% with CIED-related infections), undergoing transvenous lead extraction (TLE) procedures in three high-volume centres in the years 2006\u20132020, was conducted. Receiver operating characteristic (ROC) curve analysis was used to assess the sensitivity and specificity of neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-platelet ratio (NPR), and lymphocyte-to-platelet ratio (LPR) in the diagnosis of CIED infections, evaluate the spread of the infectious process in patients with PI and differentiate additional structures related to the presence of lead. Results: The values of NLR and NPR were significantly higher in infectious patients than non-infectious controls (3.07 vs. 2.59; p &lt; 0.001, and 0.02 vs. 0.01; p = 0.008) and the area under the ROC curve (AUC) was 0.59; p &lt; 0.001 and 0.56; p &lt; 0.001, respectively. The high specificity of the new markers in detecting the infectious process was demonstrated: 72.82% for NLR (optimal cut-off value: 3.06) and 79.47% for NPR (optimal cut off value: 0.02). The values of NLR and NPR were significantly higher in patients with vegetations than in non-infectious patients with the presence of additional lead-related masses (3.37 vs. 2.61; p &lt; 0.001 and 0.03 vs. 0.02; p = 0.008). The AUC of NLR and NPR for the prediction of vegetations was 0.65; p &lt; 0.001 and 0.60; p &lt; 0.001 with the highest specificity of NPR (82.78%) and an optimal cut-off value of 0.03. NLR and NPR were higher in patients with LRIE compared to isolated PI (4.11 vs. 2.56; p &lt; 0.001 and 0.03 vs. 0.02; p &lt; 0.001) and the ROC curve analysis for coexistence LRIE with PI showed the AUC for NLR: 0.57; p &lt; 0.001 and AUC for NPR: 0.55; p = 0.001. High specificity in the detection of coexistence between PI and LRIE was demonstrated for NLR (87.33%), with an optimal cut-off value of 3.13. Conclusions: Novel hematological markers (NLR and NPR) are characterized by high specificity in the initial diagnosis of CIED infections, with optimal cut-off values of 3.06 and 0.02. NLR is also useful in the assessment of the spread of infection in patients with PI, with a calculated optimal cut-off value of 3.13. NPR may be helpful in the differentiation of vegetation and vegetation-like masses with an optimal cut-off value of 0.03.<\/jats:p>","DOI":"10.3390\/jcm12237498","type":"journal-article","created":{"date-parts":[[2023,12,4]],"date-time":"2023-12-04T07:59:31Z","timestamp":1701676771000},"page":"7498","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Novel Hematological Parameters in the Assessment of the Extent of Cardiac Implantable Electronic Device-Related Infections"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1649-4696","authenticated-orcid":false,"given":"Maciej","family":"Polewczyk","sequence":"first","affiliation":[{"name":"Institute of Medical Sciences, Jan Kochanowski University, 25-369 Kielce, Poland"},{"name":"Department of Acute Cardiac Care, \u015awietokrzyskie Cardiology Center, 25-736 Kielce, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1091-9788","authenticated-orcid":false,"given":"Wojciech","family":"Jache\u0107","sequence":"additional","affiliation":[{"name":"2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 41-800 Zabrze, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorota","family":"Szcz\u0119\u015bniak-Sta\u0144czyk","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Medical University of Lublin, 20-059 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6632-6551","authenticated-orcid":false,"given":"Anna","family":"Polewczyk","sequence":"additional","affiliation":[{"name":"Institute of Medical Sciences, Jan Kochanowski University, 25-369 Kielce, Poland"},{"name":"Department of Cardiac Surgery, \u015awietokrzyskie Cardiology Center, 25-736 Kielce, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrzej","family":"Tomaszewski","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Medical University of Lublin, 20-059 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wojciech","family":"Brzozowski","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Medical University of Lublin, 20-059 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2441-3876","authenticated-orcid":false,"given":"Dorota","family":"Nowosielecka","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Pope John Paul II Province Hospital, 22-400 Zamo\u015b\u0107, Poland"},{"name":"Department of Cardiac Surgery, The Pope John Paul II Province Hospital, 22-400 Zamo\u015b\u0107, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrzej","family":"Kutarski","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Medical University of Lublin, 20-059 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e025600","DOI":"10.1161\/JAHA.122.025600","article-title":"Outcomes of Patients Hospitalized With Cardiovascular Implantable Electronic Device-Related Infective Endocarditis, Prosthetic Valve Endocarditis, and Native Valve Endocarditis: A Nationwide Study, 2003 to 2017","volume":"11","author":"Khaloo","year":"2022","journal-title":"J. Am. Heart Assoc."},{"key":"ref_2","first-page":"e233379","article-title":"Lead Extraction and Mortality Among Patients with Cardiac Implanted Electronic Device Infection","volume":"18","author":"Pokorney","year":"2023","journal-title":"JAMA Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.1093\/europace\/euaa076","article-title":"Infective endocarditis in patients with cardiac implantable electronic devices: A nationwide study","volume":"22","author":"Mestres","year":"2020","journal-title":"Europace"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1093\/jac\/dku383","article-title":"Report of a joint Working Party project on behalf of the BritishSociety for Antimicrobial Chemotherapy (BSAC, host organization), BritishHeart Rhythm Society (BHRS), British Cardiovascular Society (BCS), BritishHeart Valve Society (BHVS) and British Society for Echocardiography (BSE)","volume":"70","author":"Sandoe","year":"2015","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_5","first-page":"597","article-title":"Infectious complications in patients with cardiac implantable electronic devices: Risk factors, prevention, and prognosis","volume":"127","author":"Polewczyk","year":"2017","journal-title":"Pol. Arch. Intern. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1001\/archinte.167.7.669","article-title":"Permanent pacemaker and implantable cardioverter defibrillator infection: A population-based study","volume":"167","author":"Uslan","year":"2007","journal-title":"Arch. Intern. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1601","DOI":"10.1007\/s10096-014-2117-8","article-title":"Clinical manifestations of lead-dependent infective endocarditis: Analysis of 414 cases","volume":"33","author":"Polewczyk","year":"2014","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1136\/jcp.2004.017335","article-title":"Relation between lymphopenia and bacteraemia in UK adults with medical emergencies","volume":"57","author":"Wyllie","year":"2004","journal-title":"J. Clin. Pathol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/s43044-019-0014-2","article-title":"Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as independent predictors of outcome in infective endocarditis (IE)","volume":"71","author":"Meshaal","year":"2019","journal-title":"Egypt. Heart J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2012","DOI":"10.1093\/eurheartj\/ehaa010","article-title":"European Heart Rhythm Association (EHRA) international consensus document on how to prevent, diagnose, and treat cardiac implantable electronic device infections\u2014Endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm Society (LAHRS), International Society for Cardiovascular Infectious Diseases (ISCVID), and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"41","author":"Traykov","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1233","DOI":"10.1002\/clc.23660","article-title":"The role of transesophageal echocardiography in predicting technical problems and complications of transvenous lead extractions procedures","volume":"44","author":"Nowosielecka","year":"2021","journal-title":"Clin. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Li, J., Ruegamer, T., Brochhausen, C., Menhart, K., Hiergeist, A., Kraemer, L., Hellwig, D., Maier, L.S., Schmid, C., and Jantsch, J. (2022). Infective Endocarditis: Predictive Factors for Diagnosis and Mortality in Surgically Treated Patients. J. Cardiovasc. Dev. Dis., 9.","DOI":"10.3390\/jcdd9120467"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"105","DOI":"10.3343\/alm.2013.33.2.105","article-title":"Role of the Neutrophil-Lymphocyte Count Ratio in the Differential Diagnosis between Pulmonary Tuberculosis and Bacterial Community-Acquired Pneumonia","volume":"33","author":"Choonhee","year":"2013","journal-title":"Ann. Lab. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"299","DOI":"10.9738\/CC161.1","article-title":"Neutrophil-to-Lymphocyte Ratio Has a Close Association With Gangrenous Appendicitis in Patients Undergoing Appendectomy","volume":"97","author":"Ishizuka","year":"2012","journal-title":"Int. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"19","DOI":"10.5505\/tjtes.2014.20688","article-title":"Neutrophil-to-lymphocyte ratio as a predictor of acute appendicitis","volume":"20","author":"Kahramanca","year":"2014","journal-title":"Ulus. Travma Acil Cerrahi Derg"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"5575","DOI":"10.3748\/wjg.v21.i18.5575","article-title":"Is the neutrophil to lymphocyte ratio associated with liver fibrosis in patients with chronic hepatitis B?","volume":"21","author":"Kekilli","year":"2015","journal-title":"World J. Gastroenterol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"R192","DOI":"10.1186\/cc9309","article-title":"Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit","volume":"14","author":"Mathoera","year":"2010","journal-title":"Crit. Care"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"11","DOI":"10.5603\/AIT.a2019.0009","article-title":"Neutrophil-to-lymphocyte ratio in patients with gram-negative sepsis admitted to intensive care unit","volume":"51","author":"Gharebaghi","year":"2019","journal-title":"Anaesthesiol. Intensive Ther."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1007\/s15010-016-0972-1","article-title":"Role of neutrophil to lymphocyte and monocyte to lymphocyte ratios in the diagnosis of bacterial infection in patients with fever","volume":"45","author":"Naess","year":"2017","journal-title":"Infection"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1586\/14779072.2016.1154788","article-title":"Neutrophil to lymphocyte ratio (NLR) and cardiovascular diseases: An update","volume":"14","author":"Afari","year":"2016","journal-title":"Expert Rev. Cardiovasc. Ther."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"9646","DOI":"10.1038\/s41598-019-46117-8","article-title":"Prognostic implications of post-percutaneous coronary intervention neutrophil-to-lymphocyte ratio on infarct size and clinical outcomes in patients with acute myocardial infarction","volume":"9","author":"Hong","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_22","first-page":"599","article-title":"Incidence and prognosis of pacemaker lead-associated masses: A study of 1569 transesophageal echocardiograms","volume":"18","author":"Lo","year":"2006","journal-title":"J. Invasive Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1111\/j.1540-8159.2011.03034.x","article-title":"Incidence and significance of pacemaker and implantable cardioverter-defibrillator lead masses discovered during transesophageal echocardiography","volume":"34","author":"Downey","year":"2011","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1016\/j.echo.2011.03.001","article-title":"The prevalence of echocardiographic accretions on the leads of patients with permanent pacemakers","volume":"24","author":"Dundar","year":"2011","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"372","DOI":"10.2459\/JCM.0000000000000797","article-title":"Prevalence and prognosis of lead masses in patients with cardiac implantable electronic devices without infection","volume":"20","author":"Golzio","year":"2019","journal-title":"J. Cardiovasc. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1093\/europace\/eur384","article-title":"Differences in encapsulating lead tissue in patients who underwent transvenous lead removal","volume":"14","author":"Kutarski","year":"2012","journal-title":"Europace"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1093\/europace\/eus003","article-title":"Abrasions of the outer silicone insulation of endocardial leads in their intracardiac part: A new mechanism of lead-dependent endocarditis","volume":"14","author":"Kutarski","year":"2012","journal-title":"Europace"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1510","DOI":"10.1093\/europace\/eup216","article-title":"Autopsy and clinical context in deceased patients with implanted pacemakers and defibrillators: Intracardiac findings near their leads and electrodes","volume":"11","author":"Novak","year":"2009","journal-title":"Europace"},{"key":"ref_29","first-page":"238","article-title":"PET\/CT with 18 F-FDG in suspected intracardiac device-related infections: Analysis of performance and diagnostic usefulness","volume":"74","year":"2021","journal-title":"Rev. Esp. Cardiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1016\/j.jcmg.2013.08.001","article-title":"Radiolabeled WBC scintigraphy in the diagnostic workup of patients with suspected device-related infections","volume":"6","author":"Erba","year":"2013","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"521","DOI":"10.4014\/jmb.1408.08060","article-title":"Are There Standardized Cutoff Values for Neutrophil-Lymphocyte Ratios in Bacteremia or Sepsis?","volume":"25","author":"Terizi","year":"2015","journal-title":"J. Microbiol. Biotechnol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"8586418","DOI":"10.1155\/2020\/8586418","article-title":"Neutrophil-Lymphocyte Ratio in Predicting Infective Endocarditis: A Case-Control Retrospective Study","volume":"2020","author":"Chen","year":"2020","journal-title":"Mediat. Inflamm."},{"key":"ref_33","first-page":"617","article-title":"Neutrophil-to-lymphocyte ratio as a prognostic marker in infective endocarditis: In-hospital and long-term clinical results","volume":"23","author":"Bozbay","year":"2014","journal-title":"J. Heart Valve Dis."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/23\/7498\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:37:37Z","timestamp":1760132257000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/23\/7498"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,4]]},"references-count":33,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["jcm12237498"],"URL":"https:\/\/doi.org\/10.3390\/jcm12237498","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,4]]}}}