Wasting phenotype for differentiating spinal tuberculosis from spinal pyogenic infection.

IF 2.7 3区医学 Q2 CLINICAL NEUROLOGY

European Spine Journal Pub Date : 2025-10-08 DOI:10.1007/s00586-025-09434-3

Zijun Wu, Fangxu Jia, Yiyan Chen, Yunran Wang, Haoling He, Ruixin Feng, Ziyang Zhu, Qile Gao, Xiaoping Yi, Bihong T Chen

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引用次数: 0

Abstract

Background: Spinal tuberculosis (STB) and pyogenic spinal infection (PSI) often present with overlapping clinical manifestations and imaging features, leading to delayed diagnosis and suboptimal outcomes. Identifying reliable laboratory-based markers may improve early differential diagnosis.

Purposes: To investigate wasting phenotype-related clinical and laboratory indicators for differentiating STB from PSI and to establish a clinically applicable diagnostic model.

Methods: In this prospective study, 253 patients with confirmed spinal infections were enrolled, including 159 with STB (62.85%) and 94 with PSI (37.15%). Demographic, clinical, and routine laboratory data were collected. Eight candidate metabolic and inflammatory variables were assessed using univariate analyses and multivariable logistic regression. Model performance was evaluated by receiver operating characteristic (ROC) analysis, calibration testing, and Youden-derived optimal thresholds.

Results: Three key variables-body temperature, high-density lipoprotein (HDL), and blood glucose-were independently associated with STB. In the adjusted model, each 1 °C increase in temperature reduced the odds of STB by approximately 69% (OR = 0.318; 95% CI: 0.138-0.731; P = 0.009), each 1 mmol/L increase in HDL increased the odds by 3.7-fold (OR = 3.692; 95% CI: 1.311-10.394; P = 0.011), and each 1 mmol/L increase in blood glucose reduced the odds by 24% (OR = 0.764; 95% CI: 0.622-0.938; P = 0.014). The model demonstrated moderate discrimination (AUC = 0.673, 95% CI: 0.604-0.740) but good calibration (P = 0.609). ROC-derived optimal thresholds were T ≤ 36.7 °C, HDL ≥ 0.89 mmol/L, and blood glucose ≤ 5.85 mmol/L, providing practical reference points for clinical application.

Conclusion: A composite wasting phenotype defined by lower body temperature, lower blood glucose, and elevated HDL significantly improves early differentiation of STB from PSI. While individual thresholds show limited standalone diagnostic value, the combined model provides a biologically plausible, interpretable, and clinically useful tool to aid decision-making in managing spinal infections.

Levels of evidence: Level 3 (According to the Oxford CEBM 2016 criteria for diagnostic studies).

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消耗表型对脊柱结核与脊柱化脓性感染的鉴别价值。

背景：脊柱结核（STB）和化脓性脊柱感染（PSI）通常表现为重叠的临床表现和影像学特征，导致诊断延迟和预后不佳。确定可靠的基于实验室的标志物可以改善早期鉴别诊断。目的：探讨消瘦表型与STB与PSI鉴别的临床及实验室指标，建立临床适用的诊断模型。方法：本前瞻性研究纳入确诊脊柱感染患者253例，其中STB 159例（62.85%），PSI 94例（37.15%）。收集了人口统计学、临床和常规实验室数据。使用单变量分析和多变量逻辑回归评估8个候选代谢和炎症变量。通过受试者工作特征（ROC）分析、校准检验和优登衍生的最佳阈值来评估模型的性能。结果：体温、高密度脂蛋白（HDL）和血糖三个关键变量与STB独立相关。在调整后的模型中，温度每升高1℃，STB的发生率降低约69% (OR = 0.318; 95% CI: 0.138 ~ 0.731; P = 0.009)， HDL每升高1 mmol/L， STB的发生率降低3.7倍（OR = 3.692; 95% CI: 1.311 ~ 10.394; P = 0.011），血糖每升高1 mmol/L， STB的发生率降低24% （OR = 0.764; 95% CI: 0.622 ~ 0.938; P = 0.014）。该模型具有中等判别性（AUC = 0.673, 95% CI: 0.604-0.740），但具有良好的校准性（P = 0.609）。roc推导的最佳阈值为T≤36.7°C, HDL≥0.89 mmol/L，血糖≤5.85 mmol/L，为临床应用提供了实际参考点。结论：由低体温、低血糖和高密度脂蛋白升高定义的复合消耗表型可显著促进STB与PSI的早期分化。虽然单个阈值显示有限的独立诊断价值，但联合模型提供了生物学上合理的、可解释的和临床有用的工具，以帮助管理脊柱感染的决策。证据水平：3级（根据牛津CEBM 2016诊断研究标准）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Spine Journal 医学-临床神经学

CiteScore

4.80

自引率

10.70%

发文量

373

审稿时长

2-4 weeks

期刊介绍： "European Spine Journal" is a publication founded in response to the increasing trend toward specialization in spinal surgery and spinal pathology in general. The Journal is devoted to all spine related disciplines, including functional and surgical anatomy of the spine, biomechanics and pathophysiology, diagnostic procedures, and neurology, surgery and outcomes. The aim of "European Spine Journal" is to support the further development of highly innovative spine treatments including but not restricted to surgery and to provide an integrated and balanced view of diagnostic, research and treatment procedures as well as outcomes that will enhance effective collaboration among specialists worldwide. The “European Spine Journal” also participates in education by means of videos, interactive meetings and the endorsement of educative efforts. Official publication of EUROSPINE, The Spine Society of Europe